Billing Medically Unnecessary Nuclear Stress Tests Costs Urgent Care Practice $1.25 Million

Case: A physician-owned primary and urgent care practice with clinics across South Carolina has agreed to pay $1.25 million to settle claims of billing Medicare, Medicaid and TRICARE for medically unnecessary nuclear stress tests (NSTs) over a seven-year period. The feds also claim that the practice systematically billed for unnecessary Crystatin-C lab tests for detecting kidney dysfunction by allegedly adding the test to its Basic Metabolic Panel that it ran on most patients, even though the test is covered only for a limited set of patients. Significance: Before the pandemic, federal enforcers were turning up the heat for false billing of SSTs ordered by cardiologists. There are three things about NSTs, which use radioactive dyes to measure blood flow to the heart both when the patient is resting and stressed either via exercise or chemical inducement, that put them high on the list of FCA enforcement priorities: They’re very expensive; They expose patients to significant doses of radiation; and They can generate false positives resulting in the ordering of medically unnecessary invasive procedures.