Florida Cardiology PA, and 10 cardiologists in the practice have agreed to pay the US government and the state of Florida $2 million to resolve allegations that they violated the False Claims Act by submitting inflated claims to Medicare and Medicaid and billing while the physicians were not in the US, the Department of Justice has announced.
The lawsuit and settlement relate to the submission of claims that were improperly billed or performed and submitted or caused to be submitted by Florida Cardiology and its employees Sandeep Bajaj, MD, Abbas Ali, MD, Karan Reddy, MD, Claudio Manubens, MD, Milan Kothari, MD, Saroj Tampira, MD, Sayed Hussain, MD, Raviprasad Subraya, MD, Harish Patil, MD, and Edwin Martinez, MD.
According to the lawsuit and settlement agreement, Bajaj and Reddy caused Florida Cardiology to bill for more intravascular stents than were actually inserted into patients; Bajaj caused Florida Cardiology to bill for radiofrequency ablations that were not performed by him and in some instances, were not performed by a qualifying provider; and all 10 cardiologists caused the company to bill for procedures and services while they were outside the US, which providers can't do, except in limited circumstances.
Company Denies All Allegations
In a statement emailed to Medscape Medical News, Florida Cardiology said it "adamantly and vehemently denies any and all allegations raised in this civil lawsuit with the US government."
"Over the past 40 years, Florida Cardiology has been a champion for patient choice, quality, and value in the delivery of healthcare," the statement notes. "This settlement was reached by our attorneys in order to prevent the expense and inconvenience of further litigation."
The settlement resolves claims brought under the qui tam (whistleblower) provisions of the False Claims Act by Derrick Graham and Jesse Frauenhofer.
Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Graham and Frauenhofer will receive $420,000 of the proceeds from the settlement with the defendants.
"Healthcare professionals participating in Medicare and Medicaid are expected to abide by rules meant to protect patients, and to properly bill the programs on which their patients rely. Physicians who put financial gain above the well-being of patients and the integrity of federal healthcare programs will be held accountable for their actions," Omar Pérez Aybar, with the US Department of Health & Human Services Office of Inspector General, said in a DOJ news release.
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Cite this: Megan Brooks. Cardiology Group to Pay $2M to Settle False Claims Allegations - Medscape - Feb 17, 2023.