Health Care Fraud Report: Recent Federal Indictment of Cardiologist for Alleged Overbilling of Medicare

gavel-3-1409593-m.jpgOn August 21, 2014, the United States Attorney for the Northern District of Ohio, Stephen D. Dettelbach, together with representatives of the FBI and OIG, announced the indictment of a Westlake, Ohio Cardiologist for alleged health care fraud. The cardiologist is alleged to have overbilled Medicare and private insurers by approximately $7.2 million. About $1.5 million of the alleged overbillings was actually paid.

Alleged Medicare Fraud

The indictment alleges that Dr. Harold Persaud, board certified in internal medicine and cardiovascular disease, maintained a private medical practice in Westlake and had hospital privileges at St. John’s Medical Center, Fairview Hospital, and Southwest General Hospital, and used inaccurate coding to obtain reimbursement for services more costly than what was actually performed, performed medical tests that were not medically necessary, falsely recorded the existence and extent of blockage shown by cardiac catheterizations, recorded false symptoms to justify tests and procedures, and inserted stents on patients who did not have 70% or more blockage. An indictment is a charge, not evidence, and a defendant is entitled to defend himself and require the government to prove its case.

The indictment further alleges that Dr. Persaud ordered or performed other procedures that were not medically necessary, including aortograms and renal angiograms and placing a stent in an artery of one patient who had a functioning bypass, endangering the patient’s life.

In 2012, during a federal investigation relating to the subject matter of the indictment, the FBI seized numerous financial, patient and medical records and documents from Dr. Persaud’s office, according to reporting by On August 30, 2012, St. John Medical Center reported that it sent letters of apology to 23 patients, informing them that stents placed in their hearts by Dr. Persaud may not have been medically necessary, and that the hospital would pay for follow-up visits with a cardiologist of their choice. Dr. Persaud was an independent cardiologist not employed by the hospital. The hospital’s internal investigation, which led to the federal investigation, began when staff members in its cardiac catheterization lab informed the hospital’s cardiology department that Dr. Persaud’s methodology respecting stent procedures varied from protocol followed by other doctors.

The government’s press release quotes Dettelbach as saying: “The charges in this case are deeply troubling. Inflating Medicare billings alone would be bad enough. Falsifying cardiac care records, making an unnecessary referral for open heart surgery and performing needless and sometimes invasive heart tests and procedures is inconsistent with not only federal law but a doctor’s basic duty to his patients.”

St. John Medical Center provided the following statement:

In February 2012, St. John Medical Center launched an internal investigation of Dr. Harry Persaud’s cases after concerns were raised regarding certain interventional cardiology procedures. Dr. Persaud was an independent cardiologist, not employed by St. John Medical Center or University Hospitals. Outside experts were engaged to review Dr. Persaud’s cases, and impacted patients who may have received unnecessary stents were notified. St. John Medical Center also notified appropriate regulatory authorities. Since that time, St. John Medical Center has cooperated with federal officials investigating Dr. Persaud. After the issue was detected, additional quality measures were instituted to more closely monitor heart cases for similar situations going forward. An investigation was immediately launched looking into cases of all cardiologists on staff at St. John’s for any similar issues. There were none. St. John Medical Center is unable to comment further given pending litigation.

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Source: Press Release

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