Unnecessary Medical Tests Lead to $1.2 Million Settlement

piron-guillaume-96228-copy-300x200On November 28, the U.S. Department of Justice (DOJ) announced a $1.2 million settlement with Cardiovascular Consultants Heart Center, known as CVC Heart Center, and its shareholder physicians. CVC Health Center is a cardiology clinic with offices in Fresno and Clovis, California.

The CVC Heart Center along with Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks resolved state and federal False Claims Act (FCA) allegations based on their allegedly performing medically unnecessary tests and billing state and federal health care programs for them.

If you are aware of any medical false billing to a California or federal health care program like Medicare or Medi-Cal, contact the San Francisco health care fraud lawyers of Brod Law Firm right away. You may have information that would be important to the authorities. You may also have standing to bring a qui tam suit on behalf of a state and/or federal government.

The FCA Allegations

Between January 1, 2010 and December 31, 2015, CVC Heart Center submitted claims for cardiovascular nuclear imaging, also known as nuclear stress tests, which were neither medically necessary nor reasonable. Physicians at CVC Heart Center would automatically schedule patients for nuclear stress tests each year without seeing patients in person to determine if the tests were necessary and appropriate.

Nuclear stress tests are not only expensive, but also they expose patients to health risks due to significant amounts of radiations from the radioactive dye injections. Patients are additionally at risk for false positive results, which would result in an unnecessary invasive procedure. Due to all of these risks, physicians are aware that a nuclear stress test should only be ordered when medically necessary for the health and safety of the patient. The Centers for Medicare and Medicaid Services has states nuclear stress tests are not to be used as a screening procedure.  

When physicians file claims to state and federal health programs for medically unnecessary tests, these claims are considered fraudulent.

Physicians Deny Wrongdoing

While this settlement does not include the facility or doctors accepting liability, it does ensure California and the U.S. government have funds returned to them. It is an example of disagreements that can arise between the medical community and health care program and insurance providers. The physicians believe the tests were not used in a routine manner and were both reasonable and necessary for their patients, many of whom have long-term cardiac disease.

Qui Tam Suits

The settlement discussed above was not the result of a qui tam suit. Instead, the case began when a complaint was made to the U.S. Health and Human Services (HHS) Office of Inspector General Hotline. It was then pursued by state and federal authorities, including the HHS, the Federal Bureau of Investigation, and the California DOJ, Bureau of Medi-Cal Fraud and Elder Abuse.

However, many similar health care fraud cases are the result of private individuals filing FCA claims on behalf of a state and/or federal government. These are known as qui tam suits. If the government obtains a jury award or a settlement because of the information brought forward in a qui tam suit, then the whistleblower benefits from a portion of the compensation.

If you have information about possible health care fraud, call Brod Law Firm today.

(image courtesy of Piron Guillaume)