The U.S. District Court for the District of Columbia has entered judgment for more than $17 million against a nuclear cardiologist and his two companies for submitting false nuclear cardiology claims to federal and state health care programs, the Justice Department announced today. The nuclear cardiologist had practiced in the District of Columbia metropolitan area since 2002.
The government’s allegations focused on the nuclear cardiologist’s inappropriate claims for myocardial perfusion studies, commonly referred to as nuclear stress tests. These diagnostic imaging studies determine whether a patient has heart disease due to inadequate blood flow to the heart muscles. The test is usually performed in two separate phases: stress and rest. The two phases, which can be conducted on the same day or separate days, must be coded and submitted as one test. The government alleged that, contrary to these requirements, the nuclear cardiologist and his companies double-billed for multi-day nuclear stress test studies.
“This doctor fraudulently diverted critical resources from government health care programs, contributing to the rising cost of health care for all Americans,” said Ronald C. Machen Jr., U.S. Attorney for the District of Columbia. “This lawsuit was designed to hold the doctor to account for bilking the taxpayer. We will do everything in our power to obtain every cent of the $17 million this doctor now owes the American people.”
The government alleged that the nuclear cardiologist submitted false claims to Medicare, District of Columbia Medicaid, Maryland Medicaid, TRICARE and the Federal Employees Health Benefits Plan. In addition, the government alleged that the nuclear cardiologist and his companies billed under codes that did not apply to the nuclear stress test studies he administered and billed for services already included in the payment for nuclear stress test codes, such as intravenous injections, drug infusions, 3D rendering and drug administration. He and his companies also allegedly billed for services not performed.
The government filed suit against the nuclear cardiologist and his two companies under the False Claims Act, which allows the government to recover three times its damages, plus penalties, from those who submit false claims for federal funds. The state of Maryland and the District of Columbia subsequently joined the lawsuit under their respective state false claims acts.
See the DOJ Announcement