It started like any other day for these cardiology practices—patients were on the schedule, diagnostic tests were lined up, and claims were submitted to Medicare. However, questions arose regarding how provider acquisition costs for diagnostic radiopharmaceuticals were being reported versus the Centers for Medicare and Medicaid Services's (CMS's) reimbursement methodology. Over time, these discrepancies led to a $17.7 million settlement with the Department of Justice (DOJ) under the False Claims Act (FCA).
So, what exactly went wrong? More importantly, how can cardiology practices stay compliant and avoid finding themselves in a DOJ press release?
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