Sixteen Cardiology Practices Settle for Nearly $18 Million in False Claims Act Case
Bowling Green, KY – Sixteen cardiology practices across multiple states have agreed to pay a combined sum of nearly $17.7 million to resolve allegations of violating the False Claims Act by fraudulently inflating the costs of diagnostic radiopharmaceuticals reported to Medicare. These radiopharmaceuticals, crucial for diagnosing and sometimes treating various cancers and diseases, are reimbursed by Medicare Part B based on the provider’s acquisition cost. The government alleges that these practices systematically overstated their acquisition costs, leading to substantial overpayments from Medicare.
The investigation, spearheaded by the United States Attorney’s Office, Western District of Kentucky, revealed that the fraudulent reporting practices spanned varying durations, with some practices engaging in this conduct for over a decade. Medicare contractors provide explicit guidance on reimbursement procedures and emphasize the responsibility of providers to accurately report their invoice costs for these essential diagnostic drugs. The settlements highlight the government’s commitment to protecting the integrity of federal healthcare programs and holding providers accountable for fraudulent billing practices.
The settling practices and associated physicians are dispersed geographically, underscoring the widespread nature of this issue. Western Kentucky Heart & Lung Associates PSC and its associated physician, Mohammed Kazimuddin, face the largest settlement amount at $6.75 million. The Heart Clinic of Paris P.A. and Arjumand Hashmi will pay $2.6 million. Scranton Cardiovascular Physician Services LLC has agreed to a settlement of $2,369,111. These substantial sums reflect the gravity of the alleged fraudulent activities. Other notable settlements include Shannon Clinic ($996,856), Edward W. Leahey M.D. Professional Association and Edward Leahey ($894,679), and Metropolitan Cardiovascular Consultants LLC and Ayim Djamson ($846,888).
The remaining ten practices and associated individuals are responsible for settlements ranging from $740,000 down to $50,000. Cardiology Center of New Jersey LLC, along with physicians Mario Criscito, Frank Iacovone, and Sameer Kaul, will pay $740,000. Clovis Cardiology Associates LLC and Mahamadu Fuseini have a settlement of $600,000. Family Medical Specialty Clinic PLLC, Melecio Abordo, and June Abadilla will pay $409,594. James R. Higgins M.D. Inc. and James Higgins agreed to $395,537. TrustCare Health LLC’s settlement is $279,407, while Taj Medical Inc. will pay $240,000. White River Diagnostic Clinic PLC, Margaret Kuykendall, and Seth Barnes are responsible for $234,490. Veinguard Heart & Vascular Center P.C. and Fareeha Khan’s settlement is $195,000. Boulder Medical Center PC will pay $160,000, and Wellspring Cardiac Care P.A. will pay $50,000.
This case underscores the importance of accurate billing practices within the healthcare industry. Medicare relies on the honesty and integrity of providers to ensure that taxpayer dollars are used efficiently and effectively. Inflated billing practices not only strain the Medicare system but also ultimately impact the quality and accessibility of healthcare for beneficiaries. The settlements reached in this case send a strong message that fraudulent billing practices will be pursued and prosecuted vigorously.
The Department of Justice continues to emphasize its commitment to safeguarding taxpayer funds and maintaining the integrity of federal healthcare programs. The successful resolution of this case demonstrates the collaborative efforts of various agencies in identifying and addressing fraudulent activities within the healthcare sector. Further investigations and actions are anticipated as the government continues its efforts to ensure compliance and accountability within the healthcare industry. These actions serve to protect both the financial stability of Medicare and the access to quality healthcare for beneficiaries nationwide. The public is encouraged to report any suspected instances of healthcare fraud to the appropriate authorities.