U.S. Attorney Michael A. Bennett | U.S. Department of Justice
Sixteen cardiology practices and associated physicians across 12 states have agreed to pay a total of $17,761,564 to resolve allegations of violating the False Claims Act. The allegations involved overbilling Medicare for diagnostic radiopharmaceuticals.
These radiopharmaceuticals are used in diagnosing and sometimes treating certain cancers and diseases. In 13 states and the District of Columbia, Medicare Part B reimburses healthcare providers based on acquisition costs. The government alleged that these cardiology practices reported inflated costs for these drugs to Medicare. The conduct lasted at least a year, with some instances extending over ten years.
"The financial stability of federal healthcare programs depends upon providers complying with applicable billing rules," stated Principal Deputy Assistant Attorney General Brian M. Boynton from the Justice Department’s Civil Division. "We are committed to ensuring that Medicare funds are expended appropriately and to pursuing those who knowingly fail to do so."
The medical practices involved include Western Kentucky Heart & Lung Associates PSC, Heart Clinic of Paris P.A., Scranton Cardiovascular Physician Services LLC, Shannon Clinic, among others. They have agreed to pay various amounts as part of the settlement.
U.S. Attorney Matthew M. Graves for the District of Columbia emphasized the importance of whistleblowers in addressing such issues: “When people see the wrong and report it, we have the tool we need to put a stop to this type of irresponsible conduct.”
U.S. Attorney Michael A. Bennett for the Western District of Kentucky added, “This office is committed to protecting our federal health care programs, and we will hold accountable anyone who seeks to exploit them.”
Special Agent in Charge Maureen Dixon from HHS-OIG highlighted their ongoing efforts: “HHS-OIG will continue to work with our law enforcement partners to investigate alleged false claims act violations and ensure the integrity of the Medicare program.”
The civil settlement includes claims brought under the qui tam provisions by relators Jasjit Walia and Preet Randhawa in both jurisdictions mentioned earlier. They will receive more than $2.7 million from these settlements.
This resolution resulted from collaboration between various departments within the Justice Department and assistance from HHS offices.
The investigation underscores government efforts against healthcare fraud using tools like the False Claims Act.
Trial Attorney James Nealon alongside Assistant U.S Attorneys Ben Schecter, Matt Weyand (Western District), John Truong, Stephen DeGenaro (District) handled this matter.
It should be noted that these settlements resolve allegations only; no determination of liability has been made.
