Ashish Pal, MD, an interventional cardiologist from Orlando, Florida, has agreed to pay $6.75 million to resolve allegations that he performed medically unnecessary procedures, the Department of Justice has announced.
Pal owns and operates Interventional Cardiology & Vascular Consultants, PLC, with locations in Orlando, Sebring, and Davenport, Florida.
Federal prosecutors alleged that, between 2013 and 2019, Pal knowingly submitted false claims to Medicare and other federal healthcare programs for interventional procedures.
Specifically, the government contended that Pal:
Performed ablations and stent procedures on veins that did not qualify for treatment under accepted standards of medical practice
Overstated the degree of reflux and the diameter of veins in two medical records to make the ablations appear to meet generally recognized medical standards, when, in fact, they did not
Falsely documented patient symptoms and conservative therapy measures in medical records to justify the ablation and stent procedures
Performed ablations on asymptomatic patients for cosmetic purposes; and
Placed vein stents in patients in excess of the contemporaneous standards of medical practice
The government also contended that, in many cases, the ablations were performed either exclusively or primarily by ultrasound technicians outside their scope of practice.
"Physicians are expected to perform procedures only when they have a legitimate medical basis to do so. The department will pursue those who waste taxpayer funds and subject patients to unwarranted medical care," Acting Assistant Attorney General Brian Boynton, of the Justice Department's Civil Division, said in a news release.
"Our office is committed to protecting vulnerable patients from those who put financial gain ahead of patients' needs. We will continue to hold accountable those who abuse the nation's healthcare programs at the expense of the taxpayers," Acting US Attorney Karin Hoppmann, of the Middle District of Florida, added.
As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants signed an integrity agreement with the Health & Human Services Office of Inspector General (HHS-OIG).
The agreement includes training and reporting requirements as well as a quarterly claims review conducted by an independent review team that includes at least one board-certified interventional cardiologist.
Any breach in the terms of the agreement could result in penalties and, possibly, exclusion from federal health programs such as Medicare and Medicaid.
"When physicians enrich themselves by performing medically unnecessary procedures on Medicare and Medicaid beneficiaries, they threaten their patients' health and divert taxpayer funds meant to pay for necessary care," said HHS-OIG Special Agent in Charge Omar Pérez Aybar.
"We will continue to work hard with our law enforcement partners to ensure that healthcare providers who engage in such abusive behavior are held accountable," he said.
The settlement agreement is neither an admission of liability by Pal nor a concession by the US that its claims are not well founded.
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Cite this: Florida Cardiologist Settles Suit for Alleged Unneeded Procedures - Medscape - Sep 15, 2021.