Consumer Fraud

Kentucky cardiologists settle health care fraud charges brought by whistleblowers

whistleblower Kentucky cardiologists settle health care fraud charges brought by whistleblowersTwo Kentucky cardiologists have agreed to pay $380,000 to settle allegations made by whistleblowers that they violated the U.S. False Claims Act, federal Anti-Kickback Statute, and the Stark Law by making “sham agreements” with a London, Ky., hospital that resulted in referrals for cardiology procedures and other health care services.

According to the U.S. Justice Department, Dr. Satyabrata Chatterjee and Dr. Ashwini Anand jointly own Cumberland Clinic, a physician group that provides cardiology services. The government alleged that St. Joseph Hospital of London, Kentucky had agreements with the doctors under which the hospital paid the physicians to provide fictitious management services in exchange for Cumberland Clinic referring patients to the hospital for cardiology services and other medical treatments.

The U.S. alleges that this arrangement violated the Stark Law, which forbids a hospital from billing Medicare for certain services referred by physicians with whom it has a financial relationship. The arrangement, the government asserted, also violated the Anti-Kickback Statute, which prohibits individuals and companies from offering, paying, soliciting, or receiving money and other incentives in exchange for referrals for medical services covered by Medicare and other government health care programs

“Financial relationships between health care providers that put profits over patients are a threat to the programs upon which millions of Americans depend,” said Kerry Harvey, U.S. Attorney for the Eastern District of Kentucky. “We will continue to use all the tools available to us to safeguard our federally funded healthcare programs from those who seek to profit from them through illegal means.”

In addition to the payments, which were based on the physicians’ financial abilities, Drs. Chatterjee and Anand have entered into integrity agreements with U.S. Department of Health and Human Services, which mandate they undergo substantial internal compliance reforms and have a third party audit their federal health care claims for the next three years.

Saint Joseph Hospital previously agreed to pay the U.S. $16.5 million to settle whistleblower allegations that it entered into inappropriate and illegal contracts with Drs. Chatterjee and Anand, and for billing Medicare for unnecessary and excessive cardiology procedures performed by other members of the doctors’ Cumberland Clinic.

The settlement stems from a whistleblower complaint filed by three Lexington, Ky., cardiologists under the False Claims Act, which allows private individuals to sue on behalf of the federal government. The three whistleblowers in this case, Drs. Michael Jones, Paula Hollingsworth, and Michael Rukavina, will collectively receive $68,400 as their share of the recovery.

Sources:

U.S. Department of Justice