On May 2, 2017, Michael Mirando, an owner of Holter Labs, which provided cardiac monitoring services, was found guilty after a week long federal trial of 15 counts of health care fraud for submitting bills to insurance companies for tests and services that were never performed from 2009 to 2016.
This case was before Judge Percy Anderson and sentencing is scheduled for August 21, 2017. After the jury verdict, Mr. Mirando signed a stipulation indicating that his home had been bought with proceeds from the business and thus there will likely be a forfeiture component to this case which can be used for restitution.
Holter Labs was a company that provided physicians with equipment for cardio monitoring and let the physician bill the patients' insurance for the professional components (hookup and interpretation) and the company billed for the technical component. The government presented evidence that Holter Labs submitted bills for services never ordered (such as 30-day tests) and for services the devices could not perform (such as brain scans and oxygen studies). The government alleged that $7 million in billing was for services never performed and $1 million was for duplicate date of services and that Holter Labs collected at least $2.5 million on these false claims.
These type of companies have been under scrutiny even without alleged false billing. Companies offer physicians a revenue stream where they send the equipment for free to the physicians' offices, have the data downloaded for the physicians who get to bill for the professional component. Since holter monitoring is not a designated health service the Stark rules do not apply but it should be determined whether providing the software and printing reports could be consideration for the referral of the technical patient billing. Any arrangement with the companies should be reviewed for compliance.
Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law