In a recent press release, the Department of Justice applauds the concerted efforts of the Department of Health and Human Services with the FBI in identifying and investigating allegations of billing fraud spanning nearly six years. According to allegations, Texas-based Valley Heart Consultants was engaging in the practice of performing sub-standard heart monitoring procedures while billing for the full service. As a result, the office has agreed to repay $3.9 million to American taxpayers, as well as enter into a three-year corporate integrity agreement. The defendants have since publicly defended against the allegations by publishing notices in local newspapers accusing the government of targeting “minutia” and unfairly focusing on the healthcare industry in its fight against fraud.
Interestingly, this is not the first time the physician staff of Valley Heart has undergone False Claims Act scrutiny. The office agreed to pay $5.5 million in installments in 2013, as well as a staggering $27 million for similar conduct in 2009.
Background of Current Case Against Valley Heart
According to allegations, Valley Heart offered patients nuclear stress tests and physical examinations at their clinic that did not meet industry standards and were not compensable by government programs like Medicare and Medicaid. In order to qualify for reimbursement from federal programs, physicians must adhere to a specific set of guidelines as to the proper way to administer care and conduct patient consultations. Deviations from these procedures are considered grounds for liability under the False Claims Act if found to be intentional.
In the case against Valley Heart, investigators allege that not only were the stress tests and examinations sub-par and not congruent with industry standards, but they were performed by non-physician members of the Valley Heart staff. These tests were then billed to Medicare and Medicaid as rendered by a physician, resulting in a greater profit for Valley Heart at the expense of taxpayers. Many of the nuclear stress tests ordered were medically unnecessary and involved injections of nuclear medicine by unlicensed staff members. The complaint also alleges medically unnecessary ultrasounds, coronary angiographies, echocardiograms, and carotid doppler studies, which were later billed to Medicare.
This case commenced in 2007 by two former employees of Valley Heart and their reward amount has not been disclosed at this time.
Public Response by FCA Defendants
In an obscure move, two doctors employed by Valley Heart published a public notice entitled “The Truth About Valley Heart Consultants’ Settlement With Medicare and Medicaid.” In sum, the notice reiterated Valley Heart’s assertions that a licensed nuclear medical technologist is always present during stress tests and the entire department is supervised by Dr. Moises Bravo – a physician licensed in Mexico. The doctors contend they are “dead set against fraud” and recognize that no office “is perfect.”
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