An Ohio cardiologist sentenced last week to 20 years in prison for convincing patients to undergo unnecessary tests and procedures says the government used the Affordable Care Act to target him, according to The Guardian.
Dr. Harold Persaud was convicted of submitting $29 million worth of fraudulent claims to Medicare and private insurers. Federal prosecutors claimed Persaud convinced patients to undergo unnecessary and expensive nuclear stress tests, stent procedures, cardiac catheterizations, and even recommended coronary artery bypass surgery for which he could perform additional follow-up testing.
But Persaud remains adamant there was no intent to defraud payers, and that the ACA forced the feds to target him in an effort to save money by cutting down on expensive procedures.
"I did make some mistakes and I take full responsibility for that, when I dictated my notes, but none of it was fraudulent. I made some billing errors, but I did nothing wrong, medically," he told The Guardian.
Justin Shammot, supervisory special agent with the FBI's Cleveland office tells a different story, painting Persaud as someone who was "good at manipulating patients," and calling the scheme "the worst kind of healthcare fraud you can have."
Increasingly, investigators have targeted cardiologists for medically unnecessary procedures following a report last year that Medicare overpays for many cardiac device implants. In October, the Department of Justice (DOJ) reached a $250 million settlement with more than 450 hospitals in 43 states that implanted cardiac devices in violation of Medicare coverage requirements.
In Indiana, Medicare's fee-for-service model drove three cardiologists to perform unnecessary surgeries on nearly 300 patients while the hospital turned a blind eye. Other high profile cardiologists like Asad Qamar--Medicare's second highest paid physician--was banned from Medicare earlier this year after the DOJ joined several whistleblower lawsuits claiming he billed Medicare for unnecessary procedures.
- read The Guardian article