Legal Services for Cardiologists
The Health Law Group has had tremendous success advising and representing cardiologists in business transactions, government investigations, and criminal proceedings. Our attorneys know how serious and devastating a conviction can be for our clients, which is why we devote all of our resources to fighting for the most favorable outcome possible for them.
We are strategic negotiators and open-minded problem solvers, but our number one value is the countless hours of hard work we invest in every client who retains us.
Healthcare Fraud Committed by Cardiologists
Due to the fact that cardiologists are tasked with diagnosing and treating conditions involving one of the most vital organs in the human body, cardiologists have tremendous power and influence. Patients who are told that they are suffering from a heart condition are more likely to defer to a doctor’s orders than they might otherwise be, due to heart health importance.
The types of procedures cardiologists perform are often invasive, expensive and carry considerable risk. Consequently, the impact of healthcare fraud committed by cardiologists often extends far beyond financial damages, and penalties are accordingly severe.
Common Schemes Committed by Cardiologists
A common healthcare fraud charge cardiologists may face involves recommending unnecessary medical services. These services can range from relatively harmless testing to invasive and potentially life-threatening surgeries.
Additional types of healthcare fraud charges faced by cardiologists include the following:
- Submitting False Claims: This occurs whenever you submit a fraudulent claim for reimbursement for any service. Perhaps you provided a less expensive service than the one you claimed or alleged you provided more services than you actually provided, or claimed you provided a service when you in fact provided no service at all. False claims also involve providing misinformation regarding your patient’s symptoms or diagnoses to justify medically unnecessary treatment. Merely submitting a claim for reimbursement in connection with a medically unnecessary service can be considered a false claim, even if you did not overtly present false information.
- Medicare/Medicaid Fraud: Both federal and state governments have need-based healthcare benefit programs funded by taxpayers. Fraud occurs when you submit false claims to these programs in the manner described above, although any false information submitted could constitute fraud. For example, falsely reporting information regarding your license or facility to meet Medicare eligibility requirements would be prosecuted as Medicare Fraud.
- Illegal Receipt of Kickbacks: Cardiologists often work with other healthcare providers, including diagnostic testing facilities, and referral relationships are common. While you are legally permitted to refer your patients to an outside facility you trust, you are not permitted to receive cash or other incentives in connection with such referrals.
- Conspiracy to Commit Healthcare Fraud: This can arise any time you willfully act in tandem with another provider to execute a scheme to defraud.
- Mail/Wire Fraud: Mail and wire fraud occurs any time you use those channels to submit false information. Due to the fact that reimbursement claims are not generally hand delivered, mail and wire fraud often arises in connection with a healthcare fraud scheme.
- Making False Claims the False Claims Act;
- the Social Security Act; and
- the Federal Anti Kickback Statute.
Said charges include:
- Healthcare Fraud;
- Conspiracy to Commit Healthcare Fraud;
- Violations of the Federal Mail and
- Wire Fraud Statute;
- Money Laundering; and
- Medical Malpractice.
In addition, committing any form of healthcare fraud can result in criminal charges at the state level. Specific examples include:
- where your conduct defrauded a state benefits program;
- where your conduct meets the necessary elements under a state theft statute; or
- where your state has a relevant healthcare fraud statute in place.
Although you are unlikely to face charges at both the federal and state level, your specific circumstances might give rise to that possibility.
Cases of Healthcare Fraud Involving Cardiologists:
Cardiologists have been involved in various healthcare fraud cases, with penalties ranging from civil settlements to federal prison sentences. Below are just a handful of examples:
Example #1: New Jersey cardiologist Shashi Agarwal was charged with taking part in a cash kickback scheme after he accepted over $100,00 in cash from a diagnostic testing facility in exchange for referring his patients there.
Agarwal agreed to refer a certain number of patients per month and was paid $100 per Medicare or Medicaid patient he referred for an MRI, and $50 each per CAT scan patient. As such, Agarwal accepted a plea deal imposing 30 months in prison, as well as two years of supervised release and 100 hours of community service.
Example #2: Tennessee cardiologist Elie H. Korban was charged with billing Medicare and Medicaid for medically unnecessary cardiac stent placements. Cardiac stents treat coronary heart disease and are surgically placed in the coronary arteries of patients to keep their arteries open. These treatments jeopardized the health of countless patients.
Korban agreed to pay $1.15 million to resolve the claims and entered into an Integrity Agreement with the Department of Health and Human Services, which imposed greater regulations on his future activities. The fraud was initially uncovered by a fellow doctor under the whistleblower provision of the False Claims Act.
Example #3: New Mexico cardiologist Roy G. Heilbron pleaded guilty in 2017 to healthcare fraud after he executed a scheme to defraud Medicare and other health care benefit programs by submitting fraudulent claims. The scheme included billing for unnecessary tests on every new patient, justified by false diagnoses, symptoms, and observations.
Heilbron also up-coded the services he provided in reimbursement claims, and falsely documented unperformed procedures to gain reimbursement for unprovided services.
He agreed to pay restitution for the criminal conduct as part of his plea agreement and was sentenced to two years in federal prison followed by a period of supervised release.
Example #4: Kentucky cardiologist Dr. Anis Chalhoub was convicted of healthcare fraud after unnecessarily implanting over 200 pacemakers in patients. Chalhoub fraudulently told patients they could die if they did not undergo the invasive procedure they did not need.
He was sentenced to 42 months in federal prison, forced to pay $300,000 in fines and is prohibited from practicing cardiology for three years after his prison release.
Example #5: Nevada cardiologist Dr. Devendra Patel was charged with 3 counts of healthcare fraud and 36 counts of distribution of controlled substances, including oxycodone and hydrocodone.
Patel was accused of prescribing addictive pain medications to patients without a legitimate medical purpose, and for fraudulently billing Medicare and Medicaid for unprovided services.
Patel was the first person charged in Nevada following the establishment of the Justice Department’s Opioid Fraud and Abuse Detection Unit, that was created under Attorney General Jeff Sessions in 2017. The unit was created to combine data analysis forces with Assistant District Attorneys throughout the country to resolve the opioid epidemic
While the case is still being prosecuted, Patel could face significant jail time, fines, and the loss of his medical license if convicted.
Example #6: Ohio cardiologist Dr. Harold Persaud was convicted of one count of healthcare fraud, 13 counts of making false statements and one count of engaging in monetary transactions in property derived from criminal activity. His activity overbilled $7.2 million dollars to Medicare and private insurers.
Persuad’s six-year scheme defrauded Medicare and other insurers by:
- Upcoding services
- Performing unnecessary tests
- Recording false test results to justify unnecessary cardiac catheterization procedures
- Falsely recording the observance of blockages during the procedures
- Falsely reporting symptoms
Inserting unnecessary cardiac stents
- Performing unnecessary aortograms, renal angiograms, and other tests
- Referring patients for coronary artery bypass surgeries they did not need
- Increasing risk of harm to a patient by placing a stent in a stenosed artery that already had a functioning bypass
Persuad was sentenced to 20 years in federal prison and forced to pay $5.5 million in restitution, as well as $2.4 million in money judgment and forfeitures.
The Health Law Group is here to advise our clients whether they need guidance through their business transactions or counsel through a government investigation or criminal proceeding. Our attorneys are here to advocate for your best interests, and we are available whenever you need us.
The investment you make in our firm remains yours until we take action on your behalf. So even if you are unsure of whether you will ever need our services, retaining our firm is a risk-free insurance policy in your freedom.
Please contact us if you have been charged with healthcare fraud, if you want to learn more about your potential criminal liability, or if you simply want to gain a better understanding of how to best protect yourself. Our consultations are 100% confidential and risk-free.