Jackson, Michigan-based Allegiance Health d/b/a W.A. Foote Memorial Hospital (Hospital), Jackson Cardiology Associates, P.C. (Medical Practice) and Jashu R. Patel, M.D. will pay $4.1 million to settle False Claims Act charges.
The settlement resolves allegations that the defendants knowingly performed and billed Medicare, Medicaid, and other government programs for medically unnecessary cardiovascular procedures and tests, including but not limited to stress tests, cardiac catheterizations, cardiac stents, and peripheral angiography procedures.
The combined settlement was for $4,150,988.31.
The hospital settled the allegations with the federal government for $1,824.927.98 and with the State of Michigan for $126,060.33.
Dr. Patel and Jackson Cardiology settled the allegations with the federal government for $2,200,000.00. The relator will receive 19% of the proceeds.
The lawsuit was filed by Dr. Julie Kovach, M.D., a physician board certified in internal medicine, cardiology, and echocardiography who was an independent contractor with the Medical Practice.
“In the nearly thirty-years since graduation from medical school, I have had the privilege of caring for many sick individuals with heart disease and have always put the welfare of my patients as the highest priority,” Dr. Kovach said.
“I do my best to see that a patient gets the test he or she needs and doesn’t undergo tests that are not needed. The American College of Cardiology and other professional organizations have developed and disseminated ‘Appropriate Use Criteria’ for various cardiovascular procedures to assure that patients undergo the correct test and to protect patients from unnecessary procedures.”
“Most physicians and other health care providers with whom I have worked strive to deliver the best and most appropriate care to their patients.”
“However, certain health care providers put the welfare of their wallets ahead of the welfare of their patients by ordering, performing, and charging for unnecessary tests.”
“Patients with heart problems, who may be particularly vulnerable to such health care providers, should be confident that their doctor is only ordering or performing a procedure or test because it is needed, and not solely for profit. Patients should be confident that the hospital they choose is monitoring physicians and testing, thus assuring that only medically necessary procedures are being performed on patients.”
“Unnecessary cardiac procedures and tests put patients at potential risk for life threatening complications, long-term effects of radiation exposure, and additional unnecessary and risky procedures as a result of the first one.”
“Medicare and Medicaid reimburse health care providers only for procedures that are medically necessary. Paying health care providers who perform unnecessary cardiac testing and procedures increases the cost of health care to all Americans. I hope this case will remind providers that we are all accountable and will make heart patients in Michigan feel safer about the cardiac care they receive.”
Dr. Kovach was represented by Monica P. Navarro, special counsel to the Vezina Law Firm.