Source: United States Department of Justice
Sixteen separate cardiology practices and associated physicians, located across 12 states, have agreed to pay amounts totaling $17,761,564 to resolve allegations that they each violated the False Claims Act by overbilling Medicare for diagnostic radiopharmaceuticals.
Diagnostic radiopharmaceuticals are radioisotopes bound to biological molecules that target specific organs, tissues or cells within the human body and are used to diagnose and, in some cases, treat certain cancers and diseases. In 13 states and the District of Columbia, Medicare Part B reimburses healthcare providers for diagnostic radiopharmaceuticals based on the provider’s acquisition cost. In those jurisdictions, Medicare’s contractors have published guidance explaining the reimbursement methodology and providers’ obligation to accurately report their invoice costs for diagnostic radiopharmaceuticals. The government alleged that the settling cardiology practices regularly reported inflated acquisition costs to Medicare for these drugs. In each of the settlements, the conduct occurred for at least a year, and in some instances, the conduct extended over a period of more than 10 years.
“The financial stability of federal healthcare programs depends upon providers complying with applicable billing rules,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We are committed to ensuring that Medicare funds are expended appropriately and to pursuing those who knowingly fail to do so.”
The settling medical practices and associated physicians have agreed to pay the following amounts:
- Western Kentucky Heart & Lung Associates PSC and Mohammed Kazimuddin ($6,750,000)
- Heart Clinic of Paris P.A. and Arjumand Hashmi ($2,600,000)
- Scranton Cardiovascular Physician Services LLC ($2,369,111)
- Shannon Clinic ($996,856)
- Edward W. Leahey M.D. Professional Association and Edward Leahey ($894,679)
- Metropolitan Cardiovascular Consultants LLC and Ayim Djamson ($846,888)
- Cardiology Center of New Jersey LLC, Mario Criscito, Frank Iacovone, and Sameer Kaul ($740,000)
- Clovis Cardiology Associates LLC and Mahamadu Fuseini ($600,000)
- Family Medical Specialty Clinic PLLC, Melecio Abordo, and June Abadilla ($409,594)
- James R. Higgins M.D. Inc. and James Higgins ($395,537)
- TrustCare Health LLC ($279,407)
- Taj Medical Inc. ($240,000)
- White River Diagnostic Clinic PLC, Margaret Kuykendall, and Seth Barnes ($234,490)
- Veinguard Heart & Vascular Center P.C. and Fareeha Khan ($195,000)
- Boulder Medical Center PC ($160,000)
- Wellspring Cardiac Care P.A. ($50,000).
“Practices and providers who overcharge the government and fail to return overpayments compromise our healthcare programs,” said U.S. Attorney Matthew M. Graves for the District of Columbia. “When people see the wrong and report it, we have the tool we need to put a stop to this type of irresponsible conduct. So, I applaud the whistleblowers who came forward in this case.”
“These practitioners overbilled the Medicare program by grossly exaggerating the acquisition costs of drugs used in diagnostic imaging of the heart,” said U.S. Attorney Michael A. Bennett for the Western District of Kentucky. “This office is committed to protecting our federal health care programs, and we will hold accountable anyone who seeks to exploit them.”
“Medicare providers are required to be honest and accurate in the costs they report for reimbursement,” said Special Agent in Charge Maureen Dixon of the Department of Health and Human Services Office of the Inspector General (HHS-OIG). “HHS-OIG will continue to work with our law enforcement partners to investigate alleged false claims act violations and ensure the integrity of the Medicare program. ”
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by relators Jasjit Walia and Preet Randhawa in the District of Columbia and the Western District of Kentucky. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The whistleblowers will receive a total of more than $2.7 million from the settlements announced today.
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorneys’ Offices for the District of Columbia and Western District of Kentucky, with assistance from the HHS Office of Counsel to the Inspector General and Office of Investigations.
The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement, can be reported to HHS at 800-HHS-TIPS (800-447-8477).
Trial Attorney James Nealon of the Justice Department’s Civil Division and Assistant U.S. Attorneys Ben Schecter, Matt Weyand, John Truong and Stephen DeGenaro for the District of Columbia handled the matter.
The claims resolved by the settlements are allegations only. There has been no determination of liability.
View the Heart Clinic of Paris settlement agreement here.
View the Leahey settlement agreement here.
View the Scranton settlement agreement here.
View the Metropolitan settlement agreement here.
View the Shannon Clinic settlement agreement here.
View the Family Medical Specialty Clinic settlement agreement here.
View the Taj Medical settlement agreement here.
View the TrustCare settlement agreement here.
View the Veinguard settlement agreement here.
View the Wellspring settlement agreement here.
View the White River settlement agreement here.
View the WKHL settlement agreement here.
View the Boulder Medical Center settlement agreement here.
View the CCNJ settlement agreement here.