September 4, 2015

Ashland Cardiologist Indicted for Performing and Billing for Medically Unnecessary Procedures

LEXINGTON, KY—A Federal Grand Jury has returned a 27-count indictment charging an Ashland cardiologist with performing unnecessary cardiac stent procedures, in hundreds of patients, as part of a scheme to defraud Medicare, Medicaid and other insurers.

Dr. Richard E. Paulus, 68, was indicted on one count of health care fraud and 26 counts of making false statements relating to health care matters.

The indictment was announced by Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky; Howard Marshall, Special Agent in Charge of the Federal Bureau of Investigation, Louisville Division; and Derrick Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Region.

The indictment alleges Paulus devised a scheme to defraud and obtain money from Medicare, Medicaid and other insurers. The scheme took place from at least July 2008, when Paulus sold his cardiology practice to King’s Daughters Medical Center (KDMC), until July 2013, when he retired. During the time period alleged in the indictment, Paulus performed more stent placement procedures than any cardiologist in Kentucky and, at times, more than any cardiologist in the United States. As alleged, Paulus performed and billed for medically unnecessary cardiac stent procedures on hundreds of his patients.

Paulus’s arraignment is scheduled for September 24, 2015 at 11 a.m.. If convicted, Paulus faces a maximum of ten years in prison on the health care fraud count and a maximum of five years in prison on the making false statements counts. Any sentence following a conviction, however, would be imposed after the Court considers the U.S. Sentencing Guidelines and the applicable federal statutes.

The United States has also filed a parallel civil complaint against Paulus, alleging violations of the False Claims Act. The False Claims Act prohibits a person from causing the submission of false or fraudulent bills to the federal government, including federal health care programs like Medicare and Medicaid. Similar to the indictment, the United States’ False Claims Act complaint alleges that Paulus knowingly caused hundreds of false or fraudulent claims, seeking payment for medically unnecessary cardiac stent procedures, to be submitted to Medicare and Medicaid. In May 2014, KDMC agreed to pay the United States $40,900,000 to resolve claims that it was liable under the False Claims Act for billing the government for unnecessary cardiac procedures performed by its cardiologists, including Paulus.

If found liable under the False Claims Act, Paulus will be required to pay back three times the amount of loss he caused the Medicare and Medicaid programs as a result of the false or fraudulent claims, plus penalties of $5,500 to $11,000 per false claim.

An indictment is an allegation only. All defendants are presumed innocent and are entitled to a fair trial, at which the government must prove their guilt beyond a reasonable doubt.