Earlier this week, a nuclear cardiologist who has practiced in the District of Columbia (Washington, D.C.) since 2002, and two of his companies, had a judgment entered against them in the United States District Court for the District of Columbia in excess of $17 million for submitting false nuclear cardiology claims to federal and state health care programs, according to the U.S. Department of Justice.
The allegedly fraudulent claims were for nuclear stress tests that are diagnostic imaging studies that determine whether a patient has heart disease due to inadequate blood flow to the heart muscles. The nuclear stress tests are usually performed in two separate phases (stress and rest), which can be conducted on the same day or on separate days. Nonetheless, the two phases are required to be coded and submitted for reimbursement as one test. The false claims allegations involved the double billing for nuclear stress tests that were performed on multiple days.
The allegations against the cardiologist and his two companies included the submission of false claims to Medicare, District of Columbia Medicaid, Maryland Medicaid, TRICARE and the Federal Employees Health Benefits Plan; billing under codes that did not apply to the nuclear stress test studies administered and billing for services already included in the payment for nuclear stress test codes, such as intravenous injections, drug infusions, 3D rendering, and drug administration; and, billing for services not performed.
The U.S. government had filed suit against the cardiologist and his two companies under the False Claims Act in 2012, which allows the government to recover three times its damages, plus penalties, from them. Maryland and the District of Columbia subsequently joined the federal lawsuit in February 2013 under their respective state false claims acts.
As part of the summary judgment entered by the U.S. District Court, the cardiologist and his two companies were ordered to pay Maryland $305,151.24, which is triple the amount of improperly billed services reimbursed by the Maryland Medicaid Program (Maryland’s False Claims Act provides for triple damages in certain Medicaid fraud actions). The District of Columbia’s Medicaid Program will also receive triple damages, totaling more than $390,000.
The cardiologist and his two companies were also ordered to pay penalties of $5,500 for each false claim submitted to a government health care program, which totals an additional $1,672,000, from which Maryland will also receive a presently undetermined share.
In announcing the judgment, the U.S. Attorney for the District of Columbia stated, “This doctor fraudulently diverted critical resources from government health care programs, contributing to the rising cost of health care for all Americans. This lawsuit was designed to hold the doctor to account for bilking the taxpayer. We will do everything in our power to obtain every cent of the $17 million this doctor now owes the American people.”
If you are aware of a health care provider or health care facility that may have fraudulently billed a federal or state health care program for services rendered or not rendered, you may be able to file a “whistleblower lawsuit” under the False Claims Act or similar state law and thereby be entitled to share in a portion of the recovery that the government may receive as a result of your lawsuit (called qui tam).
If you have knowledge of federal health care fraud, you should promptly consult with a False Claims Act attorney (a qui tam lawyer) who may advise you regarding your whistleblower claim.
Click here to visit our website to be connected with qui tam lawyers in your state who may assist you with your whistleblower lawsuit, or call us toll-free at 800-295-3959.
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