Cardiology practice to pay $1.2M fraud settlement

To proactively remove the inevitable “but” from the RFP equation, ask suppliers these three questions.
A California cardiology practice will pay $1.2 million to settle a fraud case but denies wrongdoing.

A California cardiology practice will pay $1.2 million to resolve allegations that doctors improperly performed and billed federal and state healthcare programs for medically unnecessary cardiovascular diagnostic procedures. 

The settlement resolved allegations against Cardiovascular Consultants Heart Center, which has offices in Fresco and Clovis, that it submitted claims for cardiovascular nuclear imaging, also called nuclear stress tests, that were not medically necessary or reasonable, according to the U.S. Attorney’s Office for the Eastern District of California.

The settlement was made by the heart center and five M.D. shareholders: Kevin Boran, Michael Gen, Rohit Sundrani, Donald Gregory and William Hanks. 

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The doctors deny the allegations and say the settlement is not an admission of wrongdoing.

The U.S. Attorney’s office alleged that the doctors automatically scheduled patients for expensive nuclear stress tests on an annual basis without seeing them beforehand to determine that the procedure was necessary. The test exposes patients to a significant amount of radiation through the injection of radioactive dyes and the risk of an invasive procedure based on false positive results, the government said. A Centers for Medicare & Medicaid Services local coverage determination prohibits the use of the tests as a screening procedure.

The center’s attorney, Patric Hooper, told The Fresno Bee that rather than spend hundreds of thousands of dollars to litigate the case, the doctors reluctantly agreed to pay to settle the case in order to put it behind them.

The doctors wanted to get the results of nuclear imaging scans in advance of appointments with patients who had longstanding cardiac disease so they could review the results and discuss treatment, he said. “These doctors continue to be excellent doctors and this is anything but a fair resolution,” Hooper told the newspaper.

RELATED: Amid deep cuts across HHS, Trump’s budget maintains focus on healthcare fraud enforcement

Fighting healthcare fraud is a priority for the Department of Justice under the leadership of Attorney General Jeff Sessions.

Healthcare fraud attorneys told FierceHealthcare in March that the additional funding in President Donald Trump's proposed budget for the Health Care Fraud and Abuse Control program, especially with more than $15 billion in cuts to other agencies within the Department of Health and Human Services, is a clear signal that healthcare fraud enforcement will remain a priority under the Trump administration.

“The funding increase shows that this administration seems poised to follow the lead of past administrations in keeping the spotlight on healthcare fraud enforcement,” said Tony Maida, an attorney at McDermott Will & Emory in New York who previously served as a senior prosecutor at the OIG. 

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