Independent Diagnostic Testing Facilities Fraud

An Independent Diagnostic Testing Facilities (IDTF) is a facility that is separate and independent from a hospital or physician office, where patients go to obtain certain x-rays, scans, and other imaging and diagnostic tests that are ordered by treating physicians.  For more than a decade, various HHS-OIG reports and advisory opinions have highlighted IDTF fraud as an area of concern.

Medicare recognizes that some tests may be performed under the general supervision of a physician, while other tests require direct or personal supervision. For procedures that require “direct or personal supervision,” the physician must be in the office suite and immediately available to furnish assistance and direction during the entire performance of the procedure.

The government has been aggressive against IDTFs that skirt these physician supervision requirements, particularly when there is potential for serious patient harm. For example, the government has intervened in qui tam cases against radiology IDTFs that allegedly administered contrast dye during MRI scans on patients without proper physician supervision. These allegations are troubling as a potential adverse side effect is anaphylactic shock.

Based on previous intervened qui tam recoveries, the government has also shown an interest in pursuing the following IDTF fraud schemes:

  • Billing for diagnostic tests referred by certain non-physicians. The regulations are clear that Medicare does not pay for diagnostic test orders made by certain non-physicians, including chiropractors. To circumvent this prohibition, some IDTFs have allegedly accepted such orders from certain non-physicians by billing for them as if the tests were actually ordered by an IDFT-employed physician.
  • Performing and billing for diagnostic procedures that were never actually ordered by the patients’ treatment providers.  IDTFs are not permitted to add any procedures without a written order from the treating physicians.
  • Submitting claims to Medicare for services performed at locations that were not enrolled as authorized Medicare providers and billing Medicare for those services as if they had actually been performed at a different facility that was properly enrolled with Medicare.
  • Giving kickbacks to referring physicians for the purpose of soliciting referrals from these physicians. Some IDTFs have allegedly provided key referral sources financial incentives in the forms of lunches, gift cards, and tickets to concerts or sporting events in exchange for receiving business from these physicians.

 

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