In a landmark healthcare fraud case, one Louisiana-based cardiologist recently closed the books on a concurrent criminal-civil crackdown on his fraudulent billing and accounting practices. The doctor, along with two medical offices, recently settled the civil False Claims Act side of the matter. The settlement occurred nearly seven years after his conviction for 51 counts of criminal medical fraud, which was punished by a sentence of ten years in prison and $562,000 in restitution. The doctor began serving his sentence in 2012, after years of appellate wrangling to reduce the term of incarceration.
The False Claims Act allegations sprung from suspicions by a fellow cardiologist colleague who worked with the doctor at one of the hospitals in which both had privileges. Shortly thereafter, the government opted to intervene in the case and launched its own in-depth investigation into the fraudulent scheme. At this time, the details of the whistleblower’s qui tam reward amount has not been publicly disclosed. However, whistleblowers involved in cases in which the government has opted to intervene can receive up to 25 percent of the total value of the settlement or verdict.
Details of the case against defamed cardiologist
The case against the Louisiana practitioner is particularly alarming, especially considering the invasive and risky procedures being performed on unsuspecting patients without a medical need for the surgeries. According to the allegations, the doctor was performing unnecessary angioplasty procedures on patients who were not in need of this medical intervention. Specifically, the doctor used radiation, balloons, and other medical devices to expand patients’ arteries and clear away dangerous plaque build-up. However, as the investigations revealed, the patients in fact had healthy arteries and were placed in risky medical situations for no reason.
Over the period in question, the doctor became the top biller for cardiology services in the entire state of Louisiana. During this time, the doctor billed $3 million to private and public health insurers — $542,000 of which was deemed to be medically unnecessary. The time period in question spanned from 1999 through 2003, after which he was indicted by a Louisiana grand jury of 91 total counts of criminal healthcare fraud.
In addition to the dangerous practice of performing unnecessary and invasive cardiovascular procedures on patients, the doctor took great care in doctoring the financial records of his practice, attempting to hide the influx of income he was receiving from both private health insurance companies and public agencies like Medicare and Medicaid.
False Claims Act lawsuits can save lives
The above story illustrates that healthcare fraud can involve dire implications, and if you have a hunch something may be wrong, you could be right – just ask the doctor’s colleague! Had it not been for the courageous whistleblower willing to step forward and expose the ongoing fraud, more patients could have been exposed to the unnecessary procedures, increasing the risk for patient injury and death.
If you are aware of healthcare fraud in your place of employment and would like to speak to a knowledgeable whistleblower attorney about your information, please contact Berger Montague today.