Opinion ID: 856786
Heading Depth: 3
Heading Rank: 2

Heading: MedQuest’s Actions

Text: 1. MedQuest used non-supervising physicians to directly supervise contrast tests. In two of its facilities, the Harding Center and the Cool Springs Center, MedQuest listed board-certified radiologists (and, in one case, a non-radiologist who had been approved by CIGNA) on its CMS enrollment forms as the “supervising physicians” for the facility. These three physicians, Dr. Witt, Dr. Cooney, and Dr. Tan, were listed in the appropriate place on MedQuest’s IDTF enrollment forms. In addition, MedQuest hired other physicians to provide patient services. However, Medicare regulations require that certain procedures be conducted under direct or personal supervision—namely, for purposes of this case, contrast MRI and CT scans. CMS requires that these scans be directly supervised by one of the IDTF’s supervising physicians, and CIGNA imposes an additional requirement that the scans be approved by a specialist in radiology. The Government alleges that the centers used physicians besides those approved by CIGNA to provide direct supervision for contrast procedures, some of whom did not specialize in radiology. MedQuest concedes that some of these procedures were not supervised by the approved physician personnel, although it maintains that all procedures received supervision by a physician, approved or otherwise. MedQuest also notes that its stated policy was to limit direct supervisory responsibility to those physicians listed on its enrollment forms, as memorialized in a 2003 memo to center managers stating, “[t]he supervising physician/s that I have listed on your Medicare application is the only physician/s you should use for contrast enhanced studies on Medicare patients” (emphasis in original). No. 11-6520 United States, et al. v. MedQuest, et al. Page 6 2. MedQuest purchased a physician’s practice and operated it as an independent diagnostic testing facility, without registering as an IDTF, and instead used the former practice’s billing number on claims forms. In a third Nashville-area clinic, the Charlotte Center, MedQuest submitted claims for eighteen months using the billing number of Dr. William S. Witt. This pattern arose after MedQuest bought all of the shares in Dr. Witt’s physician’s practice and began operating the center as a MedQuest facility. According to Dr. Witt, his practice effectively ended at the time of the buyout. However, Dr. Witt continued to provide patient services at all three of the Nashville-area centers at issue in this case. MedQuest characterizes the resulting arrangement as one in which William S. Witt, Inc. became a MedQuest subsidiary, and it justifies the use of Witt’s billing code on that basis. Appellant Br. at 46. MedQuest’s use of the code ended on July 1, 2005, when MedQuest re-enrolled the Charlotte Center as an IDTF. MedQuest attributes this change in enrollment to an effort to consolidate the Nashville centers under one tax ID. However, MedQuest’s chief compliance officer testified that the earlier failure to register happened because “they just messed up and didn’t get it enrolled until they decided to do the tax ID, and that’s when they saw it was still enrolled as William Witt.”