Source: Office of United States Attorneys
WASHINGTON – The U.S. Attorney’s Office announced today the resolution of False Claims Act violations against 16 separate cardiology practices and associated physicians, located across 12 states, and their agreement to pay a total of $17,761,564 to resolve allegations that they violated the False Claims Act by overbilling Medicare for diagnostic radiopharmaceuticals. The U.S. Attorney’s Office for the District of Columbia was involved in 14 of these settlements, resulting in a total of $10,601,970.97. The remaining amount was captured by the U.S. Attorney’s Office for the Western District of Kentucky. The Department of Justice also announced these settlements.
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 cost 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.
“Practices and providers who overcharge the government and fail to return overpayments compromise our healthcare programs,” said U.S. Attorney Graves. “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.”
“The integrity of federal healthcare programs depends upon compliance with billing rules that are used to determine reimbursement,” 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.”
The settling medical practices and associated physicians have agreed to pay the following amounts:
• Heart Clinic of Paris, P.A. and Arjumand Hashmi ($2.6m)
• 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)
• 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)
• Boulder Medical Center, PC ($160,000)
• (USAO-WDKY) Western Kentucky Heart & Lung Associates PSC and Mohammed Kazimuddin ($6,750,000)
• (USAO-WDKY) Family Medical Specialty Clinic, PLLC, Melecio Abordo, and June Abadilla ($409,594)
“These practitioners overbilled the Medicare program by grossly exaggerating the acquisition costs of drugs used in diagnostic imaging of the heart,” said Michael A. Bennett, United States Attorney 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, for 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 approximately $2.2 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 United States Attorney’s Offices for the District of Columbia and Western District of Kentucky, with assistance from the Department of Health and Human Services, 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 the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The matter was handled by Trial Attorney James Nealon and Assistant U.S. Attorneys Ben Schecter and Matt Weyand from Western District of Kentucky, and Stephen DeGenaro and John C. Truong from the District of Columbia.
The claims resolved by the settlement are allegations only and there has been no determination of liability.