Assistant United States Attorneys recently accused a 53-year-old cardiologist of perpetrating a scheme in states throughout the country to defraud the health care benefit programs in exchange for personal profit.
Though indicted in Pennsylvania, the physician also provided services in Florida and New York.
What was the alleged scheme?
The government’s charges were based on the physician’s use of External Counter Pulsation (ECP) treatments. Successful ECP treatments require the use of a specialized bed. The bed uses pressure cuffs to provide pressure on the patient’s lower extremities to increase circulation.
The prosecution accused the cardiologist of failing to review patients’ ultrasounds before providing treatment. This failure allegedly supported the government’s contention that the cardiologist never properly diagnosed the patient and could not support the medical necessity of the treatment. The government used this and other evidence to build a case against the cardiologist. The prosecution accused the medical professional of falsely diagnosing patients to cheat Medicare and Medicaid out of payment.
How serious are the government’s accusations against the physician?
The criminal charges are serious and the government built a strong case. The prosecution moved forward with two criminal charges, stating the physician “knowingly and willfully executed and attempted to execute a scheme to defraud health care benefit programs.”
The jury agreed. The jury convicted the accused and he now faces up to 10 years imprisonment and a fine of $250,000. Sentencing is scheduled for November.