Vezina Law Group Announces Settlement of Cardiology Medicare and Medicaid Fraud Allegations

Date: July 10, 2013

Birmingham law firm Vezina Law Group, in conjunction with the United States Department of Justice and the State of Michigan, announced today the settlement of a False Claims Act lawsuit against Allegiance Health d/b/a W.A. Foote Memorial Hospital (Hospital), Jackson Cardiology Associates, P.C. (Medical Practice) and Jashu R. Patel, M.D., all doing business in Jackson, Michigan.

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 settlement arises from a 2008 lawsuit filed in the United States District Court for the Eastern District of Michigan under the qui tam provisions of the Federal and State False Claims Acts. Both False Claims Acts allow private individuals with knowledge of fraud against a government program to file lawsuits on the government’s behalf. If the case is successful, the private plaintiffs, known as “relators,” are entitled to a percentage of the government’s recovery. The False Claims Acts provide for recovery of treble (triple) the single damages incurred by the government as a result of the fraud, as well as civil monetary penalties of between $5,500 and $11,000 per false claim submitted and statutory attorney fees.

In this case, the combined settlement was $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; whereas 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. When asked to comment on the case, she provided the following statement:

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. 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 and procedures. 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.

Relator was represented by Monica P. Navarro, special counsel to Vezina Law Group, who was assisted by attorneys Louis C. Szura and Mercedes Dordeski. The United States was represented by Assistant U.S. Attorney Joan Hartman from the Eastern District of Michigan and Assistant U.S. Attorney Jeffrey Toll from the U.S. Department of Justice. The State of Michigan was represented by Assistant Attorney General Jeffrey Schroder from the Michigan Attorney General’s Office, Medicaid Fraud Control Unit.