Scanning for Medicare Fraud

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close up of word medicare block letter

You’ve probably heard or seen advertisements for body scan services that provide early detection of potentially life-threatening disease. Doctors use 3D images of your body to look for early signs of heart or vascular disease, or cancer. Sometimes during the process, radiologists also detect cysts, aneurysms, gallstones or kidney stones, even though you may feel fine and are not experiencing any symptoms at all.

William M. Kelly, founder and medical director of Health Scan Imaging in Southern California, offers body imaging services in addition to 3D CT scans, bone density testing, high-field MRI, mammography, nuclear medicine, ultrasound, x-ray and open MRI services at 11 tropical tiki themed Southern California locations. Many of these services were provided to Medicare beneficiaries, although they were allegedly not performed in accordance to Medicare rules.

Under the whistleblower provision of the False Claims Act, a former consultant filed a lawsuit with the U.S. Department of Justice alleging Dr. Kelly submitted claims to Medicare for unsupervised radiology services and services provided at unaccredited facilities. Medicare requires that procedures, such as CT and MRI scans which involve materials to be injected into the veins, be performed under “direct physician supervision,” which means a doctor must at least be in the office while the procedure is performed. (The company’s website lists Dr. Kelly as the only physician for all 11 facilities. Correct me if I’m wrong, but it’s really hard to be in 11 places at one time.)

While Dr. Kelly is innocent until proven guilty, note that if he is found guilty of Medicare fraud, he could be subject to paying monetary damages to those impacted, as well as other penalties. Under the whistleblower provision of the False Claims Act, the former consultant can receive a share of the monetary recovery if Kelly is found guilty of committing Medicare fraud. (If only these scanning services could be used to detect the early warning signs of fraud, larege amounts of government benefits could be spared.)

Today’s Fraud of the Day comes from an article, “Radiology business with four Coachella Valley facilities sued for Medicare fraud,” published by Desert Sun on May 24, 2020.

The United States Department of Justice has intervened in a Medicare fraud case involving 11 radiology facilities in Southern California, including four in the Coachella Valley.

William M. Kelly, founder and medical director of Health Scan Imaging, allegedly violated the False Claims Act by submitting payment claims to Medicare for unsupervised radiology services and for services provided at unaccredited facilities, according to a press release by the Department of Justice.

 

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.