Medicare is a household name. It is one of the most relied upon health insurance programs in the United States. Sadly, it is known for more than just helping its beneficiaries cover their medical costs. Medicare is also known for being taken advantage of by an ever-growing list of fraudsters. According to the Southern District of Florida branch of the United States Department of Justice, VirtuOx, Inc. has been added to that list.
VirtuOx is based in Coral Springs, Florida. The company’s website defines it as “a healthcare information technology company that provides diagnostic tools and services that enable a variety of healthcare organizations and professionals to diagnose and treat diseases through vertically integrated platforms, products and services.”
VirtuOx will pay over $3 million to resolve allegations of Medicare fraud.
As the DoJ reports, this week, VirtuOx has agreed to pay $3,150,000.00 to resolve allegations that it submitted or caused to be submitted false claims to Medicare for reimbursement. According the report, from January 2016 to December 2020, VirtuOx violated the False Claims Act. The company falsely identified the place of service for certain services it performed to obtain a higher rate of reimbursement from Medicare.
“In particular, the United States alleged that, in connection with its billing for overnight pulse oximetry claims, VirtuOx knowingly submitted false claims to Medicare identifying its IDTF located in San Francisco, California as the location of service for overnight pulse oximetry tests when, in fact, no services were performed at that location in relation to the overnight oximetry claims,” the DoJ details.
It is also alleged that between January 2016 and December 2020, VirtuOx administered overnight pulse oximetry tests. The company billed Medicare for single determination pulse oximetry tests for the same patient when in fact the only test performed was the overnight test. These tests are commonly referred to as oxygen “spot checks”.
VirtuOx is accused of billing for unnecessary “spot checks”.
Because an “awake reading” is necessarily taken as part of an overnight pulse oximetry test, the separate billing of a “spot check” is redundant and therefore not necessary. The United States also alleges that VirtuOx knowingly submitted false claims by separately billing for both an oxygen “spot check” and an overnight pulse oximetry test when only an overnight pulse oximetry test was performed.
“This matter arose from a lawsuit filed by Amber Watt in federal court in Miami, Florida,” informs the DoJ, “The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The whistleblower share to be awarded in connection with the settlement is $630,000.00.”
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