Earlier this week, the U.S. Attorney’s Office in the Western District of Kentucky announced that 16 separate cardiology practices and associated physicians, located across 12 states, agreed to pay amounts totaling more than $17.7 million in order to resolve allegations that they each violated the False Claims Act by overbilling Medicare for diagnostic radiopharmaceuticals.
Diagnostic radiopharmaceuticals are radioisotopes bound to biological molecules that target specific organs, tissues or cells within the human body, and are used to diagnose and, in some cases, treat certain cancers and diseases.
In 13 states and the District of Columbia, Medicare Part B reimburses healthcare providers for diagnostic radiopharmaceuticals based on the provider’s acquisition cost. And in those jurisdictions, Medicare’s contractors have published guidance explaining the reimbursement methodology and providers’ obligation to accurately report their invoice costs for diagnostic radiopharmaceuticals.
The government alleged that the settling cardiology practices regularly reported inflated acquisition costs to Medicare for these drugs. In each of the settlements, the conduct occurred for at least a year, and in some instances, the conduct extended over a period of more than 10 years.
The settling medical practices and associated physicians have agreed to pay the following amounts:
+ More than $6.7 million from Western Kentucky Heart & Lung Associates PSC and Mohammed Kazimuddin
+ More than $2.6 million from Heart Clinic of Paris P.A. and Arjumand Hashmi
+ More than $2.3 million from Scranton Cardiovascular Physician Services LLC
+ And nearly $1 million from Shannon Clinic
+ Among others
In a written statement, U.S. Western District of Kentucky Attorney Michael Bennett said these practitioners overbilled the Medicare program by grossly exaggerating the acquisition costs of drugs used in diagnostic imaging of the heart, and that his office is committed to protecting federal health care programs, while holding accountable anyone who seeks to exploit them.
The whistleblowers will receive a total of more than $2.7 million from the settlements.
