BioTelemetry and CardioNet: The Offshore Review Behind a Domestic Workflow

In the BioTelemetry CardioNet offshore settlement, the companies agreed to pay $44,875,000 to resolve allegations that they billed federal health care programs for heart-monitoring tests performed partly overseas, often by unqualified technicians. The case reaches into the work an insider sees every day: the queue that backs up, the people assigned to clear it, and the bill that follows.

BioTelemetry and its subsidiary CardioNet, both headquartered in Pennsylvania, provided remote cardiac-monitoring services. The Department of Justice announced the settlement on December 20, 2022. Two former CardioNet employees brought the whistleblower case. Their allegations put the people reviewing the heart data, and the location of that work, at the center of the billing question.

How the ECG Data Reached India

The government alleged that BioTelemetry diverted federal beneficiaries’ electrocardiogram data to India when its domestic review process became backlogged, with senior management’s knowledge. Other federal beneficiaries’ data allegedly went directly to India.

The government alleged that CardioNet contracted with an Indian company in 2013 for diagnostic and analysis services. In the government’s account, BioTelemetry set up a workflow intended to route federal beneficiaries’ ECG data to a domestic independent diagnostic testing facility for review and analysis, then used the overseas contractor when that route could not keep up.

The tests included Holter monitoring, event monitoring and mobile cardiovascular telemetry. The federal programs named in the settlement were Medicare, TRICARE, the Veterans Health Administration and the Federal Employee Health Benefits Program. The government alleged that billing for the overseas work violated the prohibition on payment for services furnished outside the United States.

The whistleblowers’ second amended complaint identifies the contractor as Techindia Infoway in Chennai, India. It alleges that Techindia performed patient monitoring, report analysis and insurance verification. That work included reviewing the heart data itself.

Remote cardiac monitoring has several distinct steps. The complaint describes mobile telemetry devices transmitting cardiac data to a monitoring center, where the data supports review and reports. The ordering practitioner, the monitoring facility, the contractor and the billing company occupy different places in that process.

The central operational question was who analyzed the ECG data and where that person worked.

BioTelemetry Offshore ECG Technicians and the Medicare Settlement

BioTelemetry’s offshore ECG technicians were central to the Medicare settlement because the government’s allegations concerned both their location and their qualifications. The government’s account also showed how much of the review allegedly moved abroad.

For Medicare patients in 2014, technicians in India allegedly reviewed over 29% of the ECG data associated with mobile cardiovascular telemetry tests and over 78% of the data associated with event-monitoring tests. In 2015, those proportions allegedly rose to over 47% and over 88%, respectively.

According to the government, BioTelemetry began introducing technological controls in late 2015 to prevent personnel in India from accessing the domestic workflow. The government alleged that those controls were insufficient and that offshore technicians continued reviewing some federal beneficiaries’ data afterward.

The government alleged that more than 450 India-based technicians reviewed Medicare patients’ ECG data for mobile cardiovascular telemetry services billed by CardioNet during 2013 through 2018. Fewer than 3% held certification from Cardiovascular Credentialing International, according to the government, which identified it as the only recognized credentialing body for those technicians.

The alleged shortcut left taxpayers paying for cardiac review by technicians who lacked the required qualification. The whistleblowers called the outsourcing and concealment intentional:

The allegation joins two sets of records: the assignments showing who handled the data and the credential files showing that person’s qualifications.

The Records Behind the Monitoring Claim

A cardiac-monitoring claim connects a patient’s order to work performed by particular people. In this case, we would examine the routing and access records alongside technician credentials, monitoring reports and the claims submitted for the same services.

The government’s account gives that comparison a concrete focus. Backlog decisions concern how the work was assigned. The alleged failure of access controls concerns who could still reach the domestic workflow. Credential records concern whether the assigned technicians held the required qualification. Reading those records together connects a management decision to the service billed.

There is a reason an employee’s understanding of those systems matters. The 2024 Rutgers University Law Review paper Plausible Cause: Connecting the FCA and AKS in the Context of Health Care Fraud argues that companies have an informational advantage because they hold their own records and understand their billing processes. In a monitoring business, an insider may be able to explain the connection between a work queue, a technician’s assignment and a claim that looks ordinary on its own.

What the Corporate Integrity Agreement Changed

BioTelemetry entered a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General, effective December 19, 2022. It requires risk assessment and internal review, along with an independent organization’s annual assessment of medical necessity and the appropriateness of claims billed to Medicare.

Under the corporate integrity agreement, the independent reviewer compares the monitoring order, company records and ordering-practitioner records. Where the company has no documentation for a paid claim, the unsupported claim is counted as an error.

The agreement specifies a sample of 100 randomly selected paid claims per reporting period. A paid claim without documentation stays in that sample: the company cannot replace it with a better-documented one.

That last requirement gives the review teeth. A company asked to produce its strongest files can show its strongest files. This agreement requires the review to retain the unsupported claims it encounters.

The Whistleblower Case and Reward

The two former employees brought the case under the False Claims Act’s qui tam provisions. The government later joined it for settlement. The Justice Department announced that the whistleblowers would receive approximately $8.3 million together.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

Other Cardiac-Monitoring Cases Turned on Different Decisions

Cardiac-monitoring cases can concern the service ordered, the money offered for referrals or the work actually performed. The offshore settlement belongs alongside separate matters involving these companies, each with its own alleged mechanism.

In the 2015 BioTelemetry and CardioNet settlement, the government alleged that CardioNet billed mobile cardiac outpatient telemetry for patients whose mild or moderate palpitations did not justify the more expensive service. It alleged that inaccurate diagnostic codes represented greater medical need.

The 2016 MedNet settlement concerned a different incentive. MedNet allegedly charged hospitals and physicians discounted fees for monitoring, let them bill Medicare for the work and allowed them to retain the difference to induce referrals. The government placed that conduct before BioTelemetry acquired MedNet.

The 2023 BioTelemetry and LifeWatch settlement concerned allegations that LifeWatch monitoring enrollment portal choices led to more expensive services than physicians intended.

Together, these cases explain why each decision deserves attention: the order, the enrollment choice, the referral arrangement and the review assignment. They describe different decisions on the way to a cardiac-monitoring bill.

You Know Who Reviewed the Heart Data

If you know how monitoring work crossed borders or what the credential files showed, speak with our whistleblower experts about who reviewed the heart data. We work with you to build your strongest healthcare whistleblower case around those decisions and the federal claims they produced, bringing in healthcare fraud whistleblower lawyers who understand remote cardiac monitoring. We stay beside you from the first account of the workflow through the pursuit of a recovery.