On September 25, 2015, a federal jury in Ohio found an Ohio cardiologist guilty of a Medicare fraud scheme, after a four-week trial and more than a day of jury deliberations. The Ohio cardiologist was found guilty of performing unnecessary cardiac catheterizations, tests, stent insertions, and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $7.2 million. The alleged Medicare fraud scheme took place between February 16, 2006 and June 28, 2012.
The 56-year-old cardiologist was convicted of one count of health care fraud, 13 counts of making false statements, and one count of engaging in monetary transactions in property derived from criminal activity (he allegedly transferred $250,000 from his account to his wife’s account while he was under investigation). He was acquitted on one count of making a false statement.
The alleged fraud scheme included the following, according to court documents and testimony during trial:
– The cardiologist selected the billing code for each customer submitted to Medicare and private insurers, and used codes that reflected a service that was more costly than that which was actually performed;
– He performed nuclear stress tests on patients that were not medically necessary;
– He knowingly recorded false results of patients’ nuclear stress tests to justify cardiac catheterization procedures that were not medically necessary;
– He performed cardiac catheterizations on patients at the hospitals and falsely recorded the existence and extent of lesions (blockage) observed during the procedures;
– He recorded false symptoms in patient records to justify testing and procedures on patients;
– He inserted cardiac stents in patients who did not have 70 percent or more blockage in the vessel that he stented and who did not have symptoms of blockage;
– He placed a stent in a stenosed artery that already had a functioning bypass, thus providing no medical benefit and increasing the risk of harm to the patient;
– He improperly referred patients for coronary artery bypass surgery when there was no medical necessity for such surgery, which benefitted him by increasing the amount of follow-up testing he could perform and bill to Medicare and private insurers; and,
– He performed medically unnecessary stent procedures, aortograms, renal angiograms and other procedures and tests.
The government prosecutors claimed that as a result of the Ohio cardiologist’s Medicare fraud scheme, Medicare and private insurers were overbilled in the amount of approximately $7.2 million, of which Medicare and the private insurers paid approximately $1.5 million.
After the federal jury in Ohio rendered its verdict, U.S. Attorney Steven M. Dettelbach stated, “The evidence presented at this trial was troubling. Inflating Medicare billings alone would be bad enough. Falsifying cardiac care records, making an unnecessary referral for open heart surgery and performing needless and sometimes invasive heart tests and procedures is inconsistent with not only federal law but a doctor’s basic duty to his patients.”
The defendant cardiologist remains free on bond while he awaits his sentencing that is scheduled for December 18, 2015. He faces up to 20 years in prison. The federal prosecutors are also seeking forfeiture of close to $344,000 in accounts belonging to him and his wife, which is scheduled to be heard by a jury beginning on October 9, 2015.
The cardiologist has not practiced medicine since September 2012 and faces multiple medical malpractice claims filed against him, according to reports.
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