The University of Iowa (“UI") has agreed to training and payment of $16,444 to the United States to resolve allegations that UI, through its academic medical center in Iowa City, Iowa, submitted claims for payment to the Medicare program for x-ray interpretations by resident physicians where an attending physician’s review of the residents’ interpretations did not satisfy government payment requirements.
Specifically, the government alleged that it had certain civil claims against UI arising from its submission of claims for payment for resident x-ray interpretations, where review by an attending physician did not satisfy the requirements of 42 C.F.R. § 415.180, between the period July 2018 to May 2020. Under 42 C.F.R. § 415.180, a Medicare payment regulation identifying requirements for the interpretation of diagnostic radiology in a teaching setting, physician fee schedule payment may be made for x-ray interpretations if the interpretation is reviewed or performed by a physician other than a resident.
Under the settlement agreement, UI will implement mandatory physician training regarding Medicare requirements for physician fee payment for interpretations of diagnostic radiology in teaching settings.
UI cooperated fully during the investigation and did not admit to any liability as part of the settlement agreement.
This civil matter arose from an action brought under the whistleblower provisions of the False Claims Act. The whistleblower will share in the United States’ financial recovery.
The case was handled by Assistant United States Attorneys Melissa A. Carrington and Jacob A. Schunk and investigated by the U.S. Department of Health and Human Services, Office of Inspector General, and the Department of Defense, Office of Inspector General.
Court file information at https://ecf.iand.uscourts.gov/cgi-bin/login.pl.
The case file number is 19-cv-00007-CJW-KEM.
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Source: U.S. Department of Justice, Office of the United States Attorneys