A Tennessee cardiologist has agreed to pay $1.15 million to settle whistleblower allegations that he performed medically unnecessary heart stent surgeries in order to bill Medicare and Medicaid for the procedures, the U.S. Justice Department announced.
According to Derrick Jackson, a special agent with the U.S. Department of Health and Human Services who investigated the case, medically unnecessary heart stent procedures have accounted for a substantial share of Medicare and Medicaid fraud in recent years.
Cardiac stents are mesh tubes placed in coronary arteries of patients to keep their arteries open during the treatment of coronary heart disease. According to the federal prosecutors, Dr. Korban performed improper stents in Medicare and Medicaid patients from Jan. 1, 2005 through Dec. 31, 2008.
Additionally, the U.S. also claims that the doctor improperly billed Medicare for work performed by substitute doctors when he was available to perform the services himself, a violation of federal “locum tenens” rules.
“Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and can harm patients,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart Delery. “Protecting public funds and safeguarding Medicare beneficiaries continues to be a Department of Justice priority.”
Edward Stanton, U.S. Attorney for the Western District of Tennessee, said the Korban case underscores the government’s commitment to “holding accountable those who would cheat the health care system for their own personal profit.”
“We will continue to vigorously protect citizens from schemes that damage the ability of health care providers and patients to participate in a system free of false claims and dishonesty.”
The settlement resolves allegations first raised in a lawsuit filed by Dr. Wood M. Deming under the “qui tam” or whistleblower provisions of the False Claims Act, which allows private citizens with knowledge of fraud to sue on behalf of the U.S. Government and share up to 30 percent of the recovery.