When it comes to reporting healthcare fraud, the stakes can be high. In milder cases, defendants may be engaged in fraudulent billing or upcoding to pad profits and increase revenues. However, in more dire cases, defendants have been known to order medically unnecessary procedures for the sole purpose of billing Medicare and Medicaid for the costs of these services – all at the risk of patient safety and care.
In today’s case, a Cincinnati hospital affiliated with the University of Cincinnati’s UC Health is alleged to have ordered medically unnecessary spinal surgeries for dozens of patients to increase profits.[1. “Ohio Hospital to Pay $1.4 Million to Resolve False Claims Act Allegations,” eNews Park Forest, http://enewspf.com/latest-news/law-and-order/federal-and-international/64796-ohio-hospital-to-pay-4-1-million-to-resolve-false-claims-act-allegations.html.] The alarming alleged procedures placed patients in danger of paralysis, complications, and death. The allegations surface from a whistleblower lawsuit that was filed by several former patients. They are expected to share an $800,000 qui tam reward.
Details of the alarming allegations
According to the details of the qui tam lawsuit, surgeon Dr. Abubakar Atiq Durrani relied upon admitting privileges within West Chester Hospital to perform hundreds of unnecessary spinal surgeries, and employed shamelessly persuasive tactics to entice patients to consent. In one instance, Dr. Durrani is alleged to have told a patient that without immediate spinal surgery, “There was a risk of paralysis or [that] the head would fall off if the patient was in a car accident because there was almost nothing attaching the head to the patient’s body.”[2. “Grand Jury Returns 10-count Indictment Against Spine Surgeon Alleging Health Care Fraud,” Department of Justice, August 7, 2013. http://www.justice.gov/usao-sdoh/pr/grand-jury-returns-10-count-indictment-against-spine-surgeon-alleging-health-care-fraud]
In addition to these fraudulent statements, Dr. Durrani is alleged to have involved several doctors and colleagues in the scheme. After Durrani was indicted on ten criminal counts in 2013, he fled the United States and remains a fugitive today.
Qui Tam settlement
Notwithstanding the ongoing criminal investigation against Dr. Durrani, the West Chester Hospital and UC Health agreed to settle the civil matter.
The Department of Justice said in a statement, “Hospitals have a responsibility to ensure that services provided at their facilities are medically necessary and appropriate before they bill federal healthcare programs for those services….When providers charge for medically unnecessary services, we will aggressively seek remedies under the False Claims Act.”[3. “Ohio Hospital to Pay $4.1 Million to Resolve False Claims Act Allegations,” Department of Justice, October 9, 2015, http://www.justice.gov/opa/pr/ohio-hospital-pay-41-million-resolve-false-claims-act-allegations.]
The Department of Health and Human Services similarly commented, stating, “Any time greed replaces medical necessity as the primary factor in performing invasive procedures and surgeries on Medicare and Medicaid patients, our most vulnerable citizens – the elderly, disabled, and economically disadvantaged – are imperiled….Medical businesses and physicians who unnecessarily place patients at risk to boost profits will be held accountable for their actions.”
Lives could be at risk! Report healthcare fraud today.
If you are aware of possible misconduct within the healthcare industry and would like to report your findings to a reputable whistleblower attorney, please contact Berger Montague today.