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HEALTH CARE COMPANY PAYS UNITED STATES $499,000 TO SETTLE MEDICARE DISPUTE

 HEALTH CARE COMPANY PAYS UNITED STATES $499,000
 TO SETTLE MEDICARE DISPUTE
 BOSTON, July 23 /PRNewswire/ -- U.S. Attorney A. John Pappalardo and Stuart M. Gerson, Assistant Attorney General for the Civil Division of the Department of Justice, announced today that the U.S. has reached an agreement under which Park Cardiographics, Inc. of Taunton, Mass., agreed to pay $499,000 in connection with certain claims submitted during the years 1985-1988 to the Medicare program administered by the Department of Health and Human Services.
 Park is a Massachusetts corporation which provides medical testing and diagnostic services to, among others, Medicare beneficiaries. During the period Jan. 1, 1985 to Dec. 31, 1988, Park submitted claims seeking reimbursement under the Medicare program in Massachusetts for holter (or prolonged heart) monitoring services. When Park submitted the claims it used a so-called "global" procedure billing code. By employing the global code, Park was representing to Medicare that it had performed, and was entitled to, payment for the "technical" (or testing) component of the procedure as well as the "professional" (or the physician's interpretation of the test results) component of the procedure. The United States alleges that it was improper for Park to bill for these services using the global code because the patient's attending (or treating) physician, not Park, had performed the professional component. The United States alleged that, under Medicare law, only the medical provider who actually performs the service is entitled to bill and receive reimbursement from Medicare for that service. As a result, the United States alleges that Park could not bill for the professional component unless it were performed by an independent specialist who does not see the patient and who is an employee of, or affiliated with, Park.
 The settlement agreement resolves potential federal civil and administrative claims against Park and its sole shareholder, PML, Inc. No civil lawsuit had been commenced against Park. The United States was considering asserting rights under the civil provisions of the federal False Claims Act and under Medicare laws. The False Claims Act makes it unlawful to knowingly present false claims for payment to a government agency. Under the Act, the United States, if it prevails in a civil lawsuit, may recover treble its actual damages plus civil penalties of between $5,000 and $10,000 for each such false claim submitted to the United States. Under Medicare law, the United States may recover for overpayments made to a Medicare provider such as Park and may exclude a provider such as Park from the Medicare and/or Medicaid programs if certain conditions are met.
 The U.S. Attorney noted that, in the settlement agreement between the United States and Park, PARK denied any wrong doing in connection with the Medicare claims at issue.
 The case against Park was investigated by Special Agents of the Office of Inspector General of the Department of Health and Human Services in cooperation with the Utilization Review Department of C & S Administrative Services for Medicare. Settlement negotiations were handled by Assistant U.S. Attorney Suzanne E. Durrell, Deputy Chief of Pappalardo's Civil Division, Senior Trial Counsel Ronald H. Clark of the Commercial Litigation Branch of the Civil Division of the Department of Justice in Washington, D.C., and Attorneys William J. Heffron and John Meyer of the Department of Health and Human Services in Washington,
 -0- 7/23/92
 /CONTACT: Press Officer, U.S. Attorney's Office, 617-223-9445/ CO: ST: Massachusetts IN: SU:


TM -- NE013 -- 3134 07/24/92 15:58 EDT
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Publication:PR Newswire
Date:Jul 24, 1992
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