Heart monitoring service settles overbilling case for $6.4M

A company that provides outpatient cardiac monitoring agreed to pay $6.4 million to settle a case of what one federal official called “abusive billing practices.”

The Department of Justice (DoJ) announced that it and BioTelemetry reached a settlement agreement to resolve allegations that the company’s subsidiary, CardioNet, overbilled Medicare for its services. According to charges filed under the False Claims Act, CardioNet submitted claims to Medicare for services provided through its Mobile Cardiac Outpatient Telemetry monitoring system that were not medically necessary or reasonable.

Mobile Cardiac Outpatient Telemetry can monitor outpatients with suspected arrhythmias continuously in real time and transmit the data to a diagnostic center using cell phone technology. The DoJ claimed that CardioNet submitted claims for Medicare patients with mild conditions that could have been assessed with less expensive monitors, knowing that those higher-cost services were not eligible for Medicare reimbursement.

DoJ also alleged that submissions contained billing codes for more expensive services and inaccurate diagnostic codes. BioTelemetry claimed the DoJ alleged it had encouraged physicians to use nonspecified codes between November 2008 and June 2011 to ensure coverage.

“It is the company's belief that physicians utilized these non-specified codes for palpitations, a diagnosis that was permitted under the local coverage determination but for which no corresponding diagnosis code was provided,” BioTelemetry wrote in a March 25 release. “On June 29, 2011, Medicare eliminated this ambiguity by adding a specific diagnosis code for palpitations and removing the two non-specified diagnosis codes.”

Acting U.S. Attorney Annette L. Hayes for the Western District of Washington, which was involved in the investigation, called it an example of abusive billing practices and said the settlement was a message to others.

CardioNet became a subsidiary of BioTelemetry in July 2013. BioTelemetry President and CEO John Capper said the company did not agree with the allegations but it cooperated with the investigation. It settled to avoid further costs and burden, according to the release. The settlement is not an admission of wrong doing and there is no determination of liability.