A Radiology Partners affiliate has agreed to pay $2.35 million to settle allegations it violated the False Claims Act by submitting sham diagnoses for two spinal conditions. RP, meanwhile, refutes the charges.
Seoul Medical Group (SMG), subsidiary Advanced Medical Management Inc., and former president and majority owner Dr. Min Young Cha also were named in the settlement, with the payout totaling over $62 million. Between 2015 to 2021, SMG and Cha allegedly submitted claims to Medicare Advantage for two severe conditions—spinal enthesopathy and sacroiliitis—from which its patients did not suffer.
When a health plan questioned the medical group, it purportedly enlisted the help of Renaissance Imaging Medical Associates. The Northridge, California, imaging group then allegedly created radiology reports supporting the diagnosis of spinal enthesopathy, a painful condition impacting the attachment of ligaments and tendons to bones.
This resulted in increased payments from CMS to the Medicare Advantage plan that were then passed along to Seoul Medical Group.
“Providers who game the Medicare program to increase profit undermine the foundation of care and diminish patient trust in the nation’s public healthcare system,” Deputy Inspector General for Investigations Christian J. Schrank, with the Department of Health and Human Services Office of Inspector General, said in a March 26 statement. “HHS-OIG will continue to collaborate with our law enforcement partners and rigorously...
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