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Date: 05-19-2022
Case Style:
Case Number: 19-cv-61084
Judge: Robert N. Scola, Jr.
Court: United States District Court for the Southern District of Florida (Miami-Dade County)
Plaintiff's Attorney: United States Attorney’s Office and Laurence Stephan Litow, Nicholas Steven Agnello and Andrew G. Melling
Defendant's Attorney: John H. Lawrence, Joshua I. Skora, Mallory Meagan Cooney and Mark A. Rush
Description: Miami, Florida white collar criminal defense lawyers represented Defendant charged wit submitting false claims to Medicare for reimbursement.
The United States alleged that, from January 2016 to December 2020, VirtuOx violated the False Claims Act by falsely identifying the place of service for certain services it performed to obtain a higher rate of reimbursement from Medicare. In particular, the United States alleged that, in connection with its billing for overnight pulse oximetry claims, VirtuOx knowingly submitted false claims to Medicare identifying its IDTF located in San Francisco, California as the location of service for overnight pulse oximetry tests when, in fact, no services were performed at that location in relation to the overnight oximetry claims.
The United States further alleged that, from January 2016 to December 2020, VirtuOx administered overnight pulse oximetry tests and, at times, also billed Medicare for single determination pulse oximetry tests (commonly referred to as an oxygen “spot check”) for the same patient when in fact the only test performed was the overnight test. In particular, the United States alleged that, because an awake reading is necessarily taken as part of an overnight pulse oximetry test, the separate billing of a “spot check” is redundant and generally not necessary. Accordingly, the United States alleged that VirtuOx knowingly submitted false claims by separately billing for both an oxygen “spot check” and an overnight pulse oximetry test when only an overnight pulse oximetry test was performed.
Contemporaneous with the civil settlement, VirtuOx entered into a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). The five-year CIA requires, among other things, that VirtuOx retain an outside expert to perform annual claims reviews that address the place of service identified on the claim.
Juan Antonio Gonzalez, United States Attorney for the Southern District of Florida, and Omar Pérez Aybar, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced the settlement.
“The fraudulent billing of Medicare results in systemically higher medical care costs for all,” said United States Attorney Gonzalez. “My Office will continue to hold accountable those health care providers who manipulate the system to benefit their own bottom line.”
“By submitting false claims to Medicare, providers waste valuable taxpayer dollars and undermine the integrity of federal health care programs,” said Special Agent in Charge Omar Pérez Aybar, at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG will continue to investigate such actions to ensure the efficiency and integrity of these programs.”
This matter arose from a lawsuit filed by Amber Watt in federal court in Miami, Florida. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The whistleblower share to be awarded in connection with the settlement is $630,000.00.
HHS-OIG investigated the matter. Assistant United States Attorneys Jessica R. Sievert and Miriam L. Alinikoff handled the litigation.
Outcome: The Defendant agreed to pay $3.150 million to settle the claims made against it.
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Defendant's Experts:
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