JACKSON, MI – Jackson cardiologist Dr. Jashu Patel falsely interpreted stress tests for patients as abnormal to justify billing Medicare for unnecessary cardiac procedures, according to allegations in a lawsuit settled this week.
Dr. Jashu Patel
Almost 90 percent of patients who were listed as having "abnormal" stress test results at Patel's practice, Jackson Cardiology Associates, between Jan. 29 and Feb. 28, 2007 had no significant coronary artery disease, according to the complaint filed by Ann Arbor cardiologist Dr. Julie Kovach with the U.S. District Court.
Kovach, previously employed as an independent contractor cardiologist at the practice, 205 Page Ave., also alleges that an elderly woman died as result of a cardiac procedure that was not needed and requested by Patel's office.
Patel, Jackson Cardiology Associates and Allegiance Health settled in a $4 million lawsuit that alleges that all three parties fraudulently and recklessly performed unnecessary cardiac procedures and billed them to federal health care programs.
Allegiance Health, Patel and Jackson Cardiology Associates all disagree with the allegations in the lawsuit and said they decided to settle in order to devote their resources to the care of their patients.
Kovach also alleged Allegiance Health officials received multiple complaints and warnings that Patel was performing these unnecessary procedures and continued to allow him to do so. Read the entire complaint by Kovach
Kovach is expected to receive $764,700 as part of the settlement.
"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," Kovach said in a statement issued by Birmingham-based law firm Vezina Law. "Paying health care providers who perform unnecessary cardiac testing and procedures increases the cost of health care to all Americans."
Efforts to reach Kovach for additional comment were unsuccessful.
Health care fraud is a problematic issue across the country, with cases leading to settlements costing upward of hundreds of millions of dollars, said Louis Saccoccio, CEO of the Washington, D.C.-based National Health Care Anti-Fraud Association, a private-public organization comprised of private health insurers and federal and state government officials.
What is unique about the lawsuit involving Allegiance Health and Jackson Cardiology Associates is that it involved allegations of billing for unnecessary medical procedures, Saccoccio said. More commonly, health care fraud cases involve billing for procedures that were not performed in the first place, he said.
"That's a real extreme thing, as it relates to those patients," Saccoccio said about the allegations in the lawsuit against Allegiance Health and Jackson Cardiology Associates. "It has the potential to harm patients physically."
Kovach listed several patient cases between January and May 2008 and stated that they represented only a small sample of fraudulent activities by Patel and Jackson Cardiology Associates between 1998 and 2008. The following are some of the allegations filed in Kovach's complaint:
- Patel has ordered unnecessary stress tests for patients and falsified patient records to make it appear that they needed the tests.
- Patel has repeatedly ordered, performed, and billed for cardiac catheterizations for patients who did not meet any Medicare covered indications or medical guidelines.
- In many cases, Patel falsified and manufactured complaints of symptoms in patients' charts.
Dr. Jashu Patel
Allegiance settled the case for $1.8 million. Patel and Jackson Cardiology Associates settled for $2.2 million, according to the U.S. Attorney's Office.
Because the unnecessary procedures were paid for by the Medicare or Medicaid, the United States is entitled to monetary damages under the federal False Claims Act, which allows private citizens to sue those committing fraud against government programs, according to a statement from the U.S. Attorney's office.
Patel said his practice has provided care to patients in the Jackson community for more than 20 years and that the patients are the best judges of the practice.
"I'm really deeply saddened by what has occurred," Patel said about the allegations. "I want to put my resources back into the patients' care. Our patients are very supportive."
Patel has an active medical license that expires Jan. 31, 2014, according to the Michigan Department of Licensing and Regulatory Affairs. There are no complaints or disciplinary actions filed against Patel at this time, according to the office.
"It is very important to me to have excellent care in this town," Patel said. "We are trying to provide the best care for our patients."
Allegiance Health spokesman Jeff Kapuscinski said the hospital has brought in experts to review its processes and procedures to make sure they are based on evidence and best practices.
Kapuscinski said he believes there are some people who have concerns but has been pleasantly surprised by the support that the hospital has received.
"We place a great value in the trust that our patients have in our facility," he said. "Our main goal is to retain that trust that people have in us and in the care we provide."
In addition to the monetary settlement, the resolution also provides that Jackson Cardiology Associates and Allegiance Health will enter into integrity agreements with the U.S. Department of Health and Human Services Office of Inspector General.
The Office of Inspector General negotiates these agreements with health care providers and other organizations as part of the settlement, according to the department's website.
Providers agree to the obligations, and in exchange, the office agrees to not seek their exclusion from participating in Medicare, Medicaid or other federal health care programs.
An integrity agreement typically lasts five years and includes the following requirements:
- Hire a compliance officer and appoint a compliance committee
- Develop written standards and policies
- Implement an employee training program
- Retain an independent review organization to conduct annual reviews
- Establish a confidential disclosure program
- Report over-payments, ongoing investigations and legal proceedings
- Provide an implementation report and annual reports to the Office of Inspector General on the status of the institution's compliance activities.
Although health institutions are required to have a compliance program, it is a significant event for a hospital or medical practice to be under an integrity agreement, Saccoccio said.
"(Health care providers) have to show they are complying with all (governmental) regulations that are in place," Saccoccio said. "It's a pretty stringent thing that they have to comply with to ensure that this doesn't happen again."
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