United States Intervenes in Health Care Fraud Action and Obtains $4 Million in Settlement
|U.S. Attorney’s Office July 10, 2013|
The United States will receive $4 million in the settlement of a lawsuit brought under the False Claims Act against a cardiology practice and a hospital in Jackson, Michigan, United States Attorney Barbara L. McQuade announced today. McQuade was joined in the announcement by Lamont Pugh, III, Special Agent in Charge, Department of Health and Human Services Office of Inspector General (HHS-OIG), and Robert D. Foley, III, Special Agent in Charge, FBI Detroit Field Division.
The lawsuit, alleging medically inappropriate cardiology procedures, was filed by a Michigan cardiologist, Dr. Julie A. Kovach, against Jackson Cardiology Associates and its owner, cardiologist Jashu Patel M.D., and against Allegiance Health, a hospital, all located in Jackson, Michigan. The action was kept under seal while the government investigated. The government thereafter notified the defendants that it intended to intervene and prosecute the action, and the case was unsealed this week.
Dr. Patel and Jackson Cardiology Associates have now settled the case against them for $2.2 million and Allegiance Health, where many of the catheterizations were performed, has settled for $1.8 million. Dr. Kovach will receive a percentage of the recovery.
The complaint alleges that Dr. Patel and cardiologists employed by Jackson Cardiology Associates performed medically inappropriate cardiac procedures, including invasive catheterizations at Allegiance Health. Specifically, the evidence showed that Dr. Patel ordered catheterizations for patients based on findings from nuclear stress tests that he improperly read as positive. The government found that three-quarters of these patients had no significant heart blockages. These catheterizations involve snaking a hollow tube into the heart through an incision in the patient’s groin.
Dr. Kovach also alleged that Patel and Jackson Cardiology Associates performed a variety of other office-based medically unnecessary tests. A portion of the settlement with Allegiance Health also covered medically unnecessary peripheral stents performed on an outpatient basis. Because the unnecessary procedures were paid for by Medicare or Medicaid, the United States is entitled to money damages under the False Claims Act.
“This case is especially important because the defendants unnecessarily subjected patients to invasive and potentially harmful procedures. We urge other health care professionals with knowledge of medically harmful procedures to come forward, either by calling our office and asking to speak to the criminal or civil health care fraud coordinators or through the qui tam whistleblower mechanism,” McQuade said.
The case was handled by Assistant U.S. Attorneys Joan Hartman and Linda Aouate and was investigated by Special Agent John Anderson of HHS-OIG and FBI Special Agent Sean Nicol. In addition to the monetary settlement, the resolution also provides that Jackson Cardiology Associates and Allegiance Health will enter into Integrity Agreements with HHS-OIG.