Following a lengthy False Claims Act investigation by the Department of Justice and Department of Health and Human Services, a New Jersey health network has agreed to pay $3.6 million to settle allegations it unlawfully billed Medicare and Medicaid for various unnecessary or underperformed procedures.
Healthcare providers are only permitted to submit bills to Medicare and Medicaid for the actual procedure performed. However, healthcare fraud continues to be a preeminent concern for federal authorities, as practitioners across the United States are continuing to engage in wasteful fraud and abuse of taxpayer funds, particularly with regard to illegal billing practices. Most notably, practitioners like those involved in today’s case are billing the government for services never rendered, unsupervised services, and services that are more costly than those actually rendered. Known as “upcoding,” these practices can trigger major liability under the False Claims Act, including treble (triple) damages and up to an $11,000 fine per violation.
Details of the case against NJ MedCare & NJ Heart
Several years ago, a former employee of the NJ health network known as Garden State Cardiovascular reported her suspicions in a whistleblower lawsuit.[1. Press Release from Department of Justice, U.S. Attorney’s Office, District of New Jersey, “Garden State Cardiovascular Specialists P.C. Agrees To Pay $3.6 Million For Allegedly Submitting False Claims To Federal Health Care Programs,” May 28, 2015. http://www.justice.gov/usao-nj/pr/garden-state-cardiovascular-specialists-pc-agrees-pay-36-million-allegedly-submitting] In exchange for her willingness to come forward, the whistleblower is expected to receive $648,000 of the $3.6 million settlement offered by the healthcare company.
Doing business as NJ MedCare and NJ Heart, these cardiovascular service providers are alleged to have performed medically unnecessary diagnostic tests and procedures in order to boost profits and maximize payouts from Medicare and Medicaid. More specifically, the defendant is alleged to have ordered the following medically unnecessary services and tests for patients:
-Cardiovascular stress tests
-Diagnostic catheterization, injection for left ventricular atrial angiography
-Duplex scan of extracranial arteries; complete bilateral study
-Duplex scan of extremity veins
-Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts
-Cardiovascular nuclear medicine; myocardial perfusion imaging studies
-Administration of technetium tc-99m tetrofosmin, diagnostic
-Myocardial perfusion imaging
In addition to raising claims against Garden State Cardiovascular as an entity, the Department of Justice also brought individual False Claims Act lawsuits against two principal physicians in the company, Jasjit Walia M.D. and Preet Randhawa M.D.
Pursuant to the terms of the settlement agreement, the Department of Justice has agreed not to permanently exclude Garden State from participation in the Medicare and Medicaid programs.[2. Settlement agreement for United States ex rel. Cheryl Mazurek v. Garden State Cardiovascular Specialists, P.C. et al., Civil Action No. 10-4734 (D.N.J.), http://www.justice.gov/usao-nj/file/450796/download] However, the group will undoubtedly be under a close scrutiny and subject to random auditing to ensure compliance with federal and state guidelines moving forward.
Contact a confidential and reputable whistleblower attorney today
If you are aware of healthcare fraud, illegal billing practices, or suspicious patient care plans, please do not hesitate to contact the professionals of Berger & Montague, P.C. for a confidential review of your information.