Catch of the Week: Unnecessary Blood Flow Tests Led to Unnecessary Flow of Healthcare Dollars

Healthcare fraudsters routinely look for ways to extract money from federal health programs in ways that raise the least suspicion of their actions.  One of these methods is through unnecessary diagnostic testing, which can often be lucrative when conducted routinely on large groups of patients.

This week we focus on a recent settlement with Dr. Dinesh Shah and Michigan Physicians Group, P.C. (“MPG”) for $2 million to resolve allegations of unnecessary cardiac diagnostic testing.

Alleged Unnecessary Diagnostic

Dr. Shah and MPG were accused of knowingly billing the government over an eleven-year period for unnecessary cardiac diagnostic testing.  The two main unnecessary tests allegedly performed were Ankle Brachial Index (“ABI”) and Toe Brachial Index (“TBI”) tests.  These tests measure and compare blood pressure readings on various parts of the body.  The ABI test compares blood pressure in the arm and the ankle to determine if blood is flowing adequately around the body.  The TBI test measures blood pressure flow to the feet rather than the ankle.

These two tests were not the only ones at issue here.  Dr. Shah and MPG were also accused of allegedly providing unnecessary Nuclear Stress Tests.  This test was more invasive in that a small amount of radioactive tracer is injected into a patient’s veins.  The tracer is then analyzed throughout the bloodstream by a special camera that produces images and can determine the efficiency of blood flow to and through the heart.

Medically unnecessary testing can be harmful to patients especially in the event of invasive testing such as the Nuclear Stress Test.  These unnecessary tests not only reduce patient autonomy in making healthcare decisions, but allocates healthcare funding resources to places where it is not needed.

The Qui Tams and Settlement

The settlement was based on a pair of False Claims Act qui tam lawsuits brought by two different whistleblowers who both worked for MPG. Ultimately, the federal government investigated the allegations over a period of years.  One whistleblower worked as a medical biller at MPG and likely had key details on the billing of the alleged unnecessary medical tests.  It is unknown what amount or percentage of whistleblower rewards each whistleblower received.  As part of the settlement, Dr. Shah and MPG agreed to enter into an Integrity Agreement with the Department of Health and Human Services for three years.

Dr. Shah was allegedly implicated in a previous whistleblower action involving the William Beaumont Hospital where the hospital paid $84.5 million to resolve allegations of improper payments to physicians for referring patients.  All of the physicians in that matter denied the payment scheme occurred.  In that matter, four False Claims Act qui tam lawsuits were brought by whistleblowers.

Settlements such as this one and the Beaumont hospital continue to demonstrate the important role whistleblowers play in bringing alleged wrongdoing to light.  In this matter and the Beaumont matter a combined six whistleblowers brought to light alleged schemes that had the possibility of harming patients and patient choice of healthcare providers.  Whistleblowers will continue to play a key role in protecting federal health programs from fraud and protecting patients from physicians who may not have the patient’s best interests at heart.

If you have information or would like to speak to a member of the Constantine Cannon whistleblower lawyer team, please contact us for a confidential consultation.

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