This week’s Department of Justice “catch of the week” goes to Florida cardiologist, Dr. Asad Qamar, and his physician group, the Institute for Cardiovascular Excellence. On Monday, the DOJ intervened in two whistleblower lawsuits alleging Qamar and his group billed Medicare for medically unnecessary peripheral artery interventions and paid kickbacks to patients by waiving Medicare copayments irrespective of their ability to pay. See DOJ Press Release. According to a New York Times piece on the story, Qamar is one of the nation’s top-billing doctors, collecting more than $18 million in payments from Medicare in 2012. This was more than three times the amount given to the next highest-paid cardiologist.
The whistleblower lawsuits were brought under the qui tam provisions of the False Claims Act. In one of the suits, a former consultant who had been engaged in 2010 to review Medicare billings for Dr. Qamar’s practice said she became aware that he and others in the group routinely waived Medicare co-payments so a patient would not question the high cost of the procedures being performed. As a result, according to her complaint, Qamar and the group billed for an “unrealistically high percentage of expensive procedures.” The whistleblower also alleged Qamar and his practice performed a high number of procedures on vessels outside the heart where typically only a small number of patients actually require surgical procedures.
Qamar’s high billings raised questions last year when Medicare released information about how much the program paid individual physicians. Qamar defended the high level of payments, claiming that “just looking at the sheer volume of work and billings from a single physician is not a sign of wrongdoing.” He explained his medical practice, which has a caseload of 23,000 patients, handles procedures normally performed by a hospital in many other states and therefore resulted in the large payments. His attorney was equally defiant the doctor had done nothing wrong: “Dr. Qamar practices under the highest medical and ethical standards. Any claims to the contrary are unsubstantiated, and the doctor will defend himself vigorously against these baseless allegations.”
Nevertheless, the government seems undeterred in its pursuit of the doctor and its belief he has defrauded the government and endangered his patients. According to Acting Assistant Attorney General Joyce R. Branda, “performing medically unnecessary procedures puts patients at risk and contributes to the soaring costs of health care” and the government’s decision to go after Qamar and his group “evidences the Department of Justice’s efforts both to safeguard federal health care program beneficiaries and to protect public funds.” U.S. Attorney A. Lee Bentley III for the Middle District of Florida echoed these strong words: “Physicians should make medical decisions on the basis of their patients’ needs. Performing medically unnecessary procedures solely to line a physician’s pockets strains our nation’s health care system, and can also jeopardize the health and safety of patients. Fighting Medicare and other health care fraud is one of our office’s most important priorities.”
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