right reasons or wrong ones, I know it’s coming. There’s nothing preventing most salespeople from some upselling. After all, I’m the customer. I can always say no.henever I get work done on my car, it’s pretty common for the mechanic to try to upsell me. For the
Doctors can’t do that. Nor can the manufacturers of medical devices. In many cases, the patient might not even know that they’re being upsold, they just accept the treatment that they’re given. The False Claims Act prevents doctors from upselling.
The scheme here was simple: BioTelemetry Inc. and its subsidiary, LifeWatch Services Inc. sold a cardiac monitor capable of performing three different types of heart monitoring services: holter monitoring, event monitoring and telemetry. Of these, telemetry provided the highest rate of reimbursement.
They knew that their medical devices upsold both patients and doctors: the design of their online enrollment portal for the ACT-3L device caused unwitting clinical staff to select options that would enroll the patient in the most expensive service, telemetry, even when the doctor intended to order a less expensive service. On top of that, LifeWatch’s sales personnel instructed clinical staff to select the options that resulted in patients being enrolled for telemetry services, even when the sales personnel knew the clinic’s physicians intended to order less costly services.
The whistleblower: Will receive $2.3 million as a reward for exposing this fraud. The settlement agreement identifies ninety locations across the country where the United States contends BioTelemetry and Lifewatch improperly billed for telemetry services instead of event monitoring. The whistleblower was on the clinical staff at one of those locations. Despite making clear to BioTelemetry and Lifewatch on multiple occasions that physicians at his facility were ordering event monitoring and did not want telemetry, BioTelemetry and Lifewatch’s online portal nevertheless forced enrollments in telemetry.
This fraud caused real harm to patients:
I was frustrated that Defendants ignored our instructions and billed for something the doctors didn’t want. It cost taxpayers money because telemetry was much more expensive, and it hurt patients because they often ended up with higher copayments.