Article 2: Unnecessary Heart Procedures Result In Health Care Fraud Allegations and Lawsuit[2]

After being sued by the United States government, a Tennessee cardiologist agreed to pay $1.15 million in fines and damages in order to resolve allegations of violations to the False Claims Act for making claims of reimbursement to Medicaid and Medicare for services that were medically unnecessary.

During the investigation by both state and federal governments, which included the Tennessee Bureau of Investigation, found that when this cardiologist was treating patients for heart-related health care, he was including services that were not necessary and inappropriate for the treatment needed.

This cardiologist was alleged to have installed cardiac stents in coronary arteries in order to keep patients arteries open during the time that they were receiving treatment for coronary heart disease. The United States government found it unnecessary for this cardiologist to place these mesh tubes into his patients’ arteries because the arteries did not need help keeping open.

In addition to the installation of the cardiac stents, the cardiologist was also alleged to have made reimbursement claims to the Medicaid program for work performed by doctors who stood in his place for these procedures, even during times when he was able to perform the work himself.

Along with the fine of $1.15 million, this cardiologist has agreed to enter into an Integrity Agreement with the Department of Health. This ensures that the cardiologist receives enhanced monitoring and reviews, to guarantee accountability.

Article 3: Neurosurgeon Who Was  Charged WIth Health Care Fraud Also Admits to Causing Serious Bodily Injury[3]

In 2014 a neurosurgeon along with various companies and their owners were charged with health care fraud.

The allegations related to this health care fraud scheme included that these companies were paying physicians to use a specific type of spinal implant in the spinal surgeries that the physicians performed. In this case, the neurosurgeon was alleged to have agreed with these companies to use their specific implants for his surgeries in return for a special payment.

It is further alleged that the neurosurgeon only started using a specific type of spinal implant on his patients after he had some ownership and interest in it. This is because the neurosurgeon began receiving payments for their use. The United States government alleged that this interest caused him to perform excessive, unnecessary surgeries on many patients.

In addition to this civil suit, the neurosurgeon was also criminally charged. Under the criminal charge, the neurosurgeon pleaded guilty and admitted to making significant profits from performing these unnecessary spinal infusions. Further, he admitted that the spinal infusions on these patients amounted to serious bodily injury because of their invasiveness.

As a result of his acts, the United States government wanted to make an example out of him, in which it was argued that he serve federal prison and receive a large fine. In the end, the court ordered 235 months in prison and $2.3 million in restitution.