On Wednesday, November 16, at the federal courthouse in Central Islip, New York, Zwanger-Pesiri Inc., a Long Island radiology company, pleaded guilty to two counts of health care fraud for illegally performing and billing for procedures that had not been ordered by treating physicians. Zwanger-Pesiri agreed to forfeit $2.4 million in the criminal case and pay $8,153,727 million to resolve civil liability arising from its fraudulent practices.
As part of the plea agreement and criminal settlement, Zwanger-Pesiri pled guilty to a criminal information charging the company with illegally engaging in schemes to fraudulently obtain reimbursements from Medicare and Medicaid by “bundling” the tests it performed, such that when a patient’s treating physician ordered one test to be performed, Zwanger-Pesiri would automatically perform a related but unordered test. For example, between July 2009 and February 2014, when patients were referred to Zwanger-Pesiri for either a dual energy X-ray absorptiometry (DXA) bone scan or a vertebral fracture assessment (LVA), Zwanger-Pesiri would perform both tests. Similarly, between January 2008 and February 2014, when female patients were referred to Zwanger-Pesiri for either a pelvic or transvaginal ultrasound, Zwanger-Pesiri would perform both tests.
As part of the civil settlement with the United States and State of New York, Zwanger Pesiri agreed to pay $6,921,490.80 to the United States and $1,232,236.20 to New York State to resolve allegations set forth in a qui tam complaint filed by Donna Geraci and Linda Gibb. Under federal and state False Claims Act statutes, a private individual who has uncovered fraud against the government may file a suit in federal court on behalf of the United States and the State of New York. If the United States and the State are successful in resolving those claims, the individual who filed the complaint may receive a share of the recovery. In addition to resolving civil liability arising from the conduct described in the criminal information, the civil settlement resolves allegations that Zwanger-Pesiri fraudulently billed Medicare and Medicaid programs for procedures performed or supervised by physicians who were not properly credentialed with Medicare and Medicaid programs, or which were performed at an unauthorized practice location.
Finally, as part of the global settlement, Zwanger-Pesiri agreed to enter into a Corporate Integrity Agreement with HHS-OIG that will govern its future conduct and ensure careful oversight of its billing practices.