Tag: Fraud

Prominent Cardiologist Sued for Medicare Fraud

One of the top Medicare billers in the country, Central Florida cardiologist Asad Qamar, is the target of two lawsuits accusing him of systematic Medicare fraud, including padding bills and performing unnecessary procedures.

The U.S. Department of Justice’s civil division has joined in the whistleblowers’ cases on behalf of Medicare and Medicaid taxpayers.  The lawsuits, filed in 2011 and 2014, were kept secret while the DOJ investigated and debated whether to join them.

DOJ tends to limit participation to cases in which it thinks it can win a substantial recovery. They were unsealed last week by federal judges in Tampa and Ocala.

One of the whistleblowers is a medical billing consultant, Holly Taylor of  Sarasota. The other plaintiff so far has been called only “John Doe.” Under the False Claims Act, the initiators of the lawsuits stand to gain part of the money if a case ends in a settlement or a win at trial.

A call from Health News Florida to Qamar’s practice, the Institute of Cardiovascular Excellence, brought an e-mail response from attorney Greg Kehoe of the law firm Greenberg Traurig. He called the allegations “unsubstantiated” and “baseless,” and promised a vigorous defense.

“Dr. Qamar practices under the highest medical and ethical standards,” Kehoe wrote.

The John Doe complaint accuses Qamar of routinely performing unnecessary tests that brought a high Medicare payment. They include ultrasounds of blood flow in the legs, stress tests and Holter monitoring for the heart, and nuclear imaging.  Records would be falsified to include symptoms that would justify the tests, his complaint says.

In a scarier allegation, Doe’s complaint says Qamar performed unnecessary catheterizations of the heart, a procedure that can have life-threatening complications. Cardiac catheterization involves inserting a flexible tube into a blood vessel and snaking it to the heart, injecting radioactive dye and taking nuclear images to show whether the blood is flowing properly in the coronary arteries and within the heart itself.  Some patients were also subjected to unnecessary catheterization of blood vessels in arms and legs, the complaint says.

The complaint filed by Holly Taylor focuses more on billing. The consulting company that employed her assigned her as the account manager for Dr. Qamar and the Institute, reviewing their Medicare billings. She alleges that from 2008 to 2011, the US and the state of Florida were defrauded of “tens of millions of dollars.”

Taylor’s complaint says Qamar and the Institute regularly billed for procedures that were not performed at all through “upcoding,” instructing billers to code for more expensive procedures than the ones actually done. Also the physician routinely waived the 20 percent co-payment that Medicare requires patients to pay, Taylor said, probably to keep them from questioning why they were getting so many tests.

Her suit alleges that Qamar sometimes went ahead with catheterizations without first taking a history, examining the patient or checking labs.  One patient died,Taylor’s complaint says, because she needed referral to a heart surgeon but Qamar delayed it to put stents in her leg vessels.

If there was any wrongdoing at the Institute, as the suits allege, the Florida Department of Health has not found it. Both of the Qamars have clear disciplinary records with no pending state complaints, according to the DOH web site.

Qamar and the Institute are named as defendants in both lawsuits. One also lists his wife, Dr. Humera Qamar.

The Institute, which was launched in 2009, is based in Ocala and boasts two cardiac catheterization labs. The practice has grown swiftly, with offices  in Williston and two in The Villages.

According to the practice’s website, Qamar has recently launched two affiliates, the Institute of Medical Excellence in The Villages and Williston and the Limbstitute Center for Limb Salvage in Tavares.

In a New York Times article in April, Dr. Qamar said his organization has 150 employees and 23,000 patients. The article reported that in a study of U.S. physicians’ Medicare billings in 2012, Qamar was second in the nation, receiving $18.2 million. Medicare paid him four times as much as any other cardiologist.

Once an advocate, Pinellas doctor shocks authorities in prescription fraud investigation

A Clearwater doctor who advocated against pill mills has been charged with prescription drug fraud.

Dr. Lynne Columbus, 50, of Gulf Coast Pain Management on Eastland Boulevard, was arrested Monday by Pinellas County narcotics detectives, WFLA said. She had been a member of the Pinellas Prescription Drug Abuse Task Force, but had attracted the suspicion of a patient who noticed a charge for oxycodone on her insurance bill. Deputies investigated the activity, viewed surveillance tape from a Publix pharmacy and arrested her on two counts of prescription drug fraud.

“It’s mind boggling, it really blows your mind,” said Pinellas Sheriff Bob Gualtieri. “When I first heard about this I was really stunned because she was such an advocate, so involved.”

Columbus is board certified in pain management and anesthesiology, has privileges at four Pinellas hospitals and is a trustee of Sun Coast Hospital, WFLA said citing the Florida Department of Health website. She is affiliated with the USF School of Medicine, WFLA said.

Hundreds of FL Patients Affected by Data Breach

Hundreds of Tampa General Hospital patients have had their personal data stolen, the hospital said Friday.

The information included names, addresses, dates of birth, Social Security numbers, admitting diagnoses, and insurers, the hospital said in a media release.

In total, the hospital has sent letters to 675 patients, letting them know they have been affected. Those impacted were scheduled for surgical procedures between October 3, 2011 and August 7, 2014, according to Tampa General.

The hospital said that they have mailed notices to the affected patients. They said they have also set up a call center for the patients to get more information. That number is 1-877-202-4625.

The data breach came to light when the Tampa Police Department contacted the hospital to tell them that, during an arrest, they found four one-page patient cover sheets. The person who was arrested was not a TGH employee, the hospital said.

According to John Dunn, a hospital spokesperson, the information was traced back to unnamed employee, who has been with TGH since 2007 in a non-clinical role.

“(She) would enter orders, do help with scheduling,” said Dunn. “So they were allowed access to medical records, but not allowed to be accessing those records.”

Dr. Jay Wolfson, a professor of Public Health, Medicine & Pharmacy at USF, tells FOX 13 hospitals are making strides in patient confidentiality, but even those with tight security measures are still vulnerable.

“Health care institutions are the single largest source of identity theft in America right now,” said Wolfson. “If it’s happening there, it’s happening elsewhere.”

According to Wolfson, that’s because, in a hospital setting, there are often many documents in a patient’s file and many hands accessing that information.

“It’s vital that whoever’s touching them has exclusive privileges to touch only the part they’re authorized and need to touch,” Wolfson said.

The hospital has set up a call center for the patients to get more information. That number is 1-877-202-4625.

The IRS is conducting its own investigation to see if the employee committed a crime, according to Tampa police.

Study: Despite Concerns, EHRs Don’t Increase Medicare Fraud

Concerns that nationwide electronic health record (EHR) adoption could lead to widespread fraudulent coding and billing practices that result in higher healthcare spending are unfounded, according to a study from the University of Michigan Schools of Information and Public Health and the Harvard School of Public Health.

Early results of the meaningful use program show that more than half of all eligible hospitals have qualified for financial incentives. However, some experts have suggested that the increased documentation abilities of EHRs could lead to practices like upcoding, in which care providers select billing codes that reflect more intensive care or sicker patient populations, or record cloning, which involves copying and pasting the same examination findings for multiple patients. Both these issues could drive up healthcare costs by documenting and billing for care that did not occur.

“There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn’t,” Julia Adler-Milstein, Ph.D., U-M assistant professor of information said. The study, by Adler-Milstein and Ashish K. Jha, Ph.D., Harvard professor of public health, is published online in the July issue of Health Affairs.

To examine these claims, the researchers analyzed longitudinal data to determine whether U.S. hospitals that had recently adopted EHRs had greater subsequent increases in the severity of patents’ conditions and payments from Medicare, compared to similar hospitals that did not adopt. The research focused on hospitals that would be likely to change their coding practices: for-profit hospitals, hospitals in competitive markets, and hospitals with a substantial proportion of Medicare patients.

Despite widespread stories and concerns among policymakers about the potential for EHRs to increase fraudulent billing, the authors found that adopters and non-adopters increased their billing to Medicare at essentially identical rates. They found the same results among the groups of hospitals most likely to use electronic health records to increase coding and revenue.

The results also suggest that policy intervention to reduce fraud is not likely to be a good use of resources. Instead, the authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce healthcare spending and improve the quality of care.

Drug-Test Labs Battle in Tampa Court over Kickback Violations

A federal jury in Tampa began deliberations Friday afternoon on a lawsuit by Ameritox Ltd. against Millennium Laboratories, two significant players in the drug-testing business.

The eight jurors, whose verdict form is a whopping 96 pages, must decide whether Millennium’s sales gimmick of giving doctors free urine specimen test cups violates laws on health fraud.

They must weigh accusations that Millennium broke not only federal kickback laws but also rules involving unfair and deceptive business practices in Florida and five other states.

Ameritox says it should be awarded almost $19 million in actual damages for lost business, including $9.3 million in Florida. It also wants punitive damages.

“Ameritox cannot compete with illegal free supplies and equipment,” said attorney Patrick Collins. “Ameritox wants a level playing field.”

But Millennium’s attorney James Carroll said the new company has grabbed a lot of Ameritox business because it offers better service to its doctor-customers and a much shorter turnaround time.

The urine cups that Millennium provides to doctors have test strips that make it possible to do a quick drug-test check while a patient is in the office. Doctors have to promise not to bill for the tests, so there’s no fraud going on, he said.

“The cup agreement helps patients and helps doctors help patients” by revealing abuse of prescription or other drugs in time for the doctor to intervene, Carroll said. “The only one it hurts is Ameritox.”

Unless jurors reach a unanimous verdict quickly — a possibility seen as remote — U.S. District Judge Susan Bucklew said she will send them home for the weekend, to resume deliberations Monday.

Ameritox, based in Baltimore, accuses Millennium of offering doctors an illegal incentive to get their business — free plastic cups for a quick do-it-yourself urine screen that can test for multiple drugs while the patient is still in the office.  The same cups can be used to send the urine on to Millenium to confirm the result through a more elaborate set of tests, for which the company can bill public or private insurers.

Last month, Judge Bucklew granted Ameritox a partial victory, saying the actions that Millennium admits to are clearly in violation of the federal Stark Law and Anti-Kickback Statute for some of its doctor-customers, the ones who bill insurers for doing chemical analysis on the urine. But it’s not clear whether the law applies to doctors who agreed not to bill; on those, she’ll let the jury decide.

This is not a criminal case, but a civil lawsuit. So Millennium, a fast-growing upstart from San Diego,  will likely face a money penalty; the amount of damages depends on the jury’s verdict.

Even though the specimen cups cost only $5 apiece, the case is no tempest in a pee pot, says Jay Wolfson, a lawyer who won a multimillion-dollar whistleblower case last year involving laboratory kickbacks, as Health News Florida reported.

“This isn’t about a $5 cup,” said Wolfson, University of South Florida professor of public health and medicine. “It’s about a multibillion-dollar portion of the (health-care) industry.”

But as he notes, none of the parties come to the table with clean hands. Certainly not Ameritox:

Four years ago, in a federal kickback case in Tampa, Ameritox agreed to pay more than $16 million to settle charges.  The Baltimore-based company signed a five-year “corporate integrity agreement” with the Inspector General of the U.S. Department of Health and Human Services.

“It’s kind of like being on probation,” Wolfson said.

And on April 30, Preet Bharara, the U.S. attorney for the Southern District of New York State, issued a “civil investigative demand” for information on Ameritox’s own incentives for doctors, as well as a host of  billing records, lease arrangements and more.

Questions about the lease arrangements may be related to a practice that Health News Florida reported on in 2011. Drug-testing labs were paying “rent” to Florida pain-management doctors for part of their offices so they could station a collector for urine samples. The Agency for Health Care Administration told Ameritox and others that the leases were not permitted.

While the New York prosecutor’s broad demand for records doesn’t necessarily mean Ameritox has done anything wrong, it’s ominous because of the 2010 settlement.  At stake are Ameritox’s federal billings, estimated at almost $100  million a year.

Also, in mid-April, U.S. District Judge Sharon Gleason issued an order slamming Ameritox in a wrongful termination case against Millennium filed in Arizona by a former employee, Kelly Nelson.

Gleason says that all parties to the Arizona case, including Ameritox – since it was involved in the related case in Tampa, agreed to a “protective order” that would keep certain documents from becoming part of the public record.

But the judge says that Nelson gave Ameritox some depositions from Millennium employees, and Ameritox filed them as exhibits in the Tampa suit. Gleason said that since Ameritox is paying Nelson’s legal bills, the two were working in concert.

In Alaska at the time of her order, Gleason said she will return to Phoenix  in July to hear Nelson v. Millennium.  One of her tasks, she said, will be a hearing on whether Nelson and Ameritox “should be found in contempt.”

While the intertwined cases can be dauntingly complex, Wolfson said the concept is simple: If a laboratory gives a physician something free that the doctor can use to make money, that’s wrong.

“It’s not wrong if you’re in the supermarket business, but it’s wrong in health care,” he said. That’s because the gift-giver creates a financial incentive for a physician to perform a service that may not be needed.  In some cases, he said, the extra services aren’t just unnecessary but downright harmful to patients.

Besides, “it costs us all money,” Wolfson said. “That’s what the fraud laws in Medicare are all about.”

ONC queried on power to regulate health IT

Leaders of the House Energy & Commerce Committee are questioning the authority of the Office of the National Coordinator for Health Information Technology to regulate health IT under a proposed interagency framework. The letter (PDF), addressed to ONC head Dr. Karen DeSalvo, questions whether the agency is overstepping its statutory authority in proposing to oversee medium-risk health software, levy a user fee on industry members and create a safety center to look over the industry’s safety record. It is signed by Reps. Fred Upton (R-Mich.), Marsha Blackburn (R-Tenn.), Joseph Pitts (R-Kent.) and Greg Walden (R-Ore.) Blackburn introduced the SOFTWARE Act, a bill aiming to deregulate and clarify the regulations governing the sector. The Senate companion to the SOFTWARE Act, called the PROTECT Act, was introduced by Sen. Deb Fischer (R-Neb.). The lawmakers are pushing back against a regulatory process stemming from the combined efforts of the FDA, ONC and the Federal Communications Commission. Supporters of this approach say the three agencies have the proper expertise to define working regulations to govern the sector and that legislation risks enshrining sloppy rules or definitions. Critics, though, argue that the agencies have been too slow to keep up with the pace of change in the industry. The agencies issued a framework in April that would divide health technology into three bands: a high-risk band, regulated by FDA; a medium-risk band, primarily overseen by the ONC; and a low-risk band, largely left unregulated. The agencies are collecting comments on the draft report outlining the proposed framework through July 7. The House members are asking DeSalvo to explain where the ONC derives its authority to oversee the medium-risk category, which includes “most” clinical decision support software, among other software functions. As the framework envisions the ONC having oversight responsibility over a large section of the sector, these questions point to the heart of the framework’s logic. Additionally, the letter asks about a proposed Health IT Safety Center, intended to monitor the safety record of health software as used in the field, and a user-fee levy to finance it. The letter also asks to what extent the 2015 edition of EHR software requirements under the federal incentive program “represents a shift in focus from interoperability, privacy, and security … to the regulation of data collection, functionality requirements, and other areas where market forces are more likely to promote innovation and efficiency?” Dan Haley, the vice president of regulatory and governmental affairs with cloud computing EHR firm athenahealth, said in an e-mail that the House lawmakers are right to question the statutory authority of the regulatory framework, regardless of how one views the agencies’ work. “How they presume to do it without Congressional authorization is beyond me,” he said. Bradley Merrill Thompson, a lawyer with Epstein Becker Green, and a member of a working group that advised FDA, ONC and FCC on health IT regulations, likewise said the lawmakers are asking good questions. Thompson, who has advocated for the regulatory approach in public forums, said the framework “was very thin on details so I think Congress has a legitimate right to ask for more information before simply writing a large check.”