Kirtish N Patel and Nita K Patel, both aged 53, had earlier pleaded guilty to healthcare fraud.
The government’s civil complaint had alleged that they created fraudulent diagnostic test reports, forged physician signatures on these reports and then billed Medicare for the fraudulent reports.
They also billed Medicare for neurological tests that they conducted without the required physician supervision, the Justice Department said.
The lawsuit was filed under whistleblower, provisions of the False Claims Act, which allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery.
The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case.
The whistleblower who brought the misconduct to the government’s attention will receive 15 to 25 per cent of the more than USD 7.7 million recovered by the government.
According to the documents filed in the case and statements made in the court from 2006 through June 2014, Nita and Kirtish owned and operated Biosound Medical Services Inc and Heart Solutions in New Jersey, which were mobile diagnostic companies and approved medicare providers.
As per court documents, Biosound technicians would travel to the office of a primary care physician in the New York and New Jersey area to conduct diagnostic testing.
Biosound was responsible for sending the tests to a reading physician, an appropriate specialist who would interpret the results.
“After the reading physician prepared a report, Biosound was responsible for providing it to the referring physician.
Biosound was paid millions of dollars by Medicare and other payors for the diagnostic testing, the reading physician’s interpretation of the results and the reports, the prosecutors said.
Kirtish admitted to fraudulently interpreting and writing diagnostic reports produced by Biosound despite having no medical license and knowing that the reports would be used by the referring physicians to make important patient treatment decisions.
Nita assisted her husband in forging physician signatures on the fraudulently produced reports to make them appear legitimate.
The couple admitted falsely representing to Medicare that the neurological testing performed by Biosound was being supervised by a licensed neurologist, the Justice Department said.
According to reports, more than half of the diagnostic reports generated by Biosound between October 2008 and June 2014 were never actually reviewed or interpreted by a physician.
Nita and Kirtish were paid more than USD 4,386,133.75 by Medicare and private insurance companies for the fraudulent reports, which they used for personal expenses, including multiple residences and luxury vehicles, it said.
PTI