16 Cardiology Practices Across 12 States Pay $17.7M to Settle False Claims Act Allegations

On December 20, 2024, the government announced that 16 cardiology practices and physicians across 12 states will pay a total of $17,761,564 to settle claims that they overbilled Medicare for diagnostic radiopharmaceuticals and thereby violated the False Claims Act (FCA).

Diagnostic radiopharmaceuticals are “radioactive drugs that healthcare providers use for special imaging tests and for treating certain types of cancer,” per the Cleveland Clinic.  These cases concern diagnostic radiopharmaceuticals used in cardiac stress tests.  In certain states, Medicare Part B reimburses providers for diagnostic radiopharmaceuticals based on the provider’s cost to acquire the drugs.  In these partially intervened FCA cases, which were initiated by two whistleblowers who are doctors, the government alleged that the defendant cardiology practices “regularly reported inflated acquisition costs to Medicare for these drugs.”

Like so many FCA cases, the particular facts of the cases – here, involving the acquisition of and reimbursement for diagnostic radiopharmaceuticals for use in cardiac stress tests – are complicated, but the core allegations boil down to a common pattern of inflating costs and overbilling Medicare.  In many instances, the key to successfully bringing an FCA case is fitting unique, sometimes complicated facts to a tried-and-true theory of FCA liability.

Principal Deputy Assistant Attorney General Brian M. Boynton, the head of the DOJ Civil Division, said: “The financial stability of federal healthcare programs depends upon providers complying with applicable billing rules. We are committed to ensuring that Medicare funds are expended appropriately and to pursuing those who knowingly fail to do so.”

Matthew M. Graves, the U.S. Attorney for the District of Columbia, applauded the whistleblowers who came forward in this case: “Practices and providers who overcharge the government and fail to return overpayments compromise our healthcare programs. When people see the wrong and report it, we have the tool we need to put a stop to this type of irresponsible conduct.”

These FCA cases were initiated by two whistleblowers.  The qui tam or whistleblower provisions of the FCA allow private parties to initiate a lawsuit on behalf of the United States and receive a share of the recovery.  In these cases, the whistleblowers will receive over $2.7 million from the settlements.

Below is a list of settling medical practices and associated physicians that have agreed to pay the listed amounts:

• Western Kentucky Heart & Lung Associates PSC and Mohammed Kazimuddin ($6,750,000)
• Heart Clinic of Paris P.A. and Arjumand Hashmi ($2,600,000)
• Scranton Cardiovascular Physician Services LLC ($2,369,111)
• Shannon Clinic ($996,856)
• Edward W. Leahey M.D. Professional Association and Edward Leahey ($894,679)
• Metropolitan Cardiovascular Consultants LLC and Ayim Djamson ($846,888)
• Cardiology Center of New Jersey LLC, Mario Criscito, Frank Iacovone, and Sameer Kaul ($740,000)
• Clovis Cardiology Associates LLC and Mahamadu Fuseini ($600,000)
• Family Medical Specialty Clinic PLLC, Melecio Abordo, and June Abadilla ($409,594)
• James R. Higgins M.D. Inc. and James Higgins ($395,537)
• TrustCare Health LLC ($279,407)
• Taj Medical Inc. ($240,000)
• White River Diagnostic Clinic PLC, Margaret Kuykendall, and Seth Barnes ($234,490)
• Veinguard Heart & Vascular Center P.C. and Fareeha Khan ($195,000)
• Boulder Medical Center PC ($160,000)
• Wellspring Cardiac Care P.A. ($50,000).

If you would like to learn more about health care fraud, the False Claims Act, or what it means to be a whistleblower, please contact us. We will connect you with an experienced member of our whistleblower team.

Tagged in: False Claims Act, Medicare, qui tam,