Government Intervenes in Medicare Fraud Lawsuit Filed by Berger Montague Against Texas Cardiovascular Center
October 15, 2018. PHILADELPHIA—Berger Montague is pleased to announce that the government has intervened in a False Claims Act lawsuit filed by shareholder Shauna Itri, along with co-counsel, against a cardiovascular center in Texas. The lawsuit alleges that the cardiologist group defrauded the government by billing Medicare for medically unnecessary services.
An example of the medically unnecessary testing alleged in the Complaint is Enhanced External Counterpulsation, or EECP. EECP is a noninvasive treatment that uses timed, sequential inflation of pressure cuffs to augment diastolic pressure, decrease left ventricular afterload, and increase venous return. As the complaint alleges, according to the Medicare Coverage Determination, EECP is very rarely ever medically justified. A full course of EECP consists of 35 one-hour treatments, which may be offered once or twice daily, usually 5 days per week. Each session is billed to Medicare, and the provider receives approximately $137 per session; totaling approximately $4,795 per patient per EECP treatment.
In addition to EECP, defendants allegedly ordered medically unnecessary stress tests, nuclear stress tests, echocardiograms, stress echocardiograms, Doppler of the arteries and veins, cardiodynamics, event monitor and removal, polysomnography, ultrasound of the abdomen, aorta, carotid, and renal arteries on a routine basis.
The complaint also alleged that when defendants ordered blood work for patients, they routinely tested for an excessive number of potential conditions and diseases.
In the fall of 2018, the government announced that it was intervening in the case against the cardiovascular center. Shauna Itri, co-counsel for the whistleblower stated:
“Unnecessary medical care is an epidemic that costs the government, and ultimately, the taxpayers. Contact us if you know of any wasteful use of medical care and billing Medicare for unnecessary tests.”
For more than a decade, Shauna Itri has represented whistleblowers in False Claims Act lawsuits in state and federal courts throughout the United States, as well as tax and securities whistleblowers with claims under the IRS and SEC whistleblower programs. Ms. Itri received a B.A. and an M.A. from Stanford University, where she captained the University’s Women’s soccer team. She is presently an adjunct professor at Widener Law School, actively involved in pro bono work, and the 2019-2020 President of the Junior League of Philadelphia, Inc.
The Berger Montague Whistleblower, Qui Tam & False Claims Act Practice Group has represented whistleblowers in matters involving healthcare fraud, defense contracting fraud, IRS fraud, securities fraud, and commodities fraud, helping to return more than $3 billion to federal and state governments. In return, whistleblower clients retaining Berger Montague to represent them in state and federal courts have received more than $500 million in rewards.