The owners of an Elizabethtown, Kentucky cancer clinic have paid $3.7 million to settle claims that they extended the period of chemotherapy for their patients to pad their bills to the government.
“To subject cancer patients to unnecessary treatments that are physically draining and emotionally stressful is utterly unconscionable,” said Patrick McFarland, inspector general of the U.S. Office of Personnel Management.
U.S. Attorney David Hale announced Tuesday that Elizabethtown Hematology Oncology PLC and its owners agreed to pay $3,739,325 to resolve allegations that they submitted false claims for payment to the Medicare, Medicaid and the military’s medical provider for extending the duration of chemotherapy infusion treatment to patients and inappropriately billing office visits for infusion therapy.
The settlement agreement says that owners Dr. Rafiq Ur Rahman and Dr. Yusuf K. Deshmukh from 2006 to 2013 unnecessarily and improperly extended the duration of chemotherapy infusion treatment times for their patients so they could make more money. It also says they and their clinic falsely billed for office evaluations of patients receiving chemotherapy.
“Manipulating treatment protocols and lengthening infusion times to increase reimbursement reflect an extraordinary lack of regard for patient welfare and the integrity of our health care system,” Hale said in a news release.
Some of the allegations emerged from a whistleblower lawsuit filed in 2011 by Dr. Ijaz Mahmood of Elizabethtown, who alleged the clinic, to inflate billings, developed written protocols that increased chemotherapy infusion times by a factor of three or more beyond what is generally recognized.
He said Deshmukh and Rahman gave patients the appropriate dose of chemotherapy, but diluted it and prolonged treatment for hours so that they could bill more to Medicaid and Medicare, which pay in part based on how long a procedure takes.
Under the federal whistleblower law, Mahmood will receive $283,412 as part of the settlement. The doctors and the clinic agreed to pay the state of Kentucky $405,227.
Mahmood’s lawyer, John Caudill of Bowling Green, said he worked for the clinic since the 1990s and came forward with the allegations after leaving in 2011.
In addition to the $3.7 million payment, the clinic and the doctors agreed to be monitored for three years by the Office of Inspector General of the Department of Health and Human Services, although they will be allowed to continue billing to federal medical programs.
The agreement is neither an admission of liability by Rahman and Deshmukh nor a concession by the United States and the state of Kentucky that its claims are not well founded.
The doctors couldn’t be reached at the clinic or their homes.
The government may still prosecute either defendant and they are subject to federal tax charges.
In an interview Tuesday night, Marc Murphy of Louisville, the lawyer for the clinic and the doctors, said there was “not an ounce of evidence that a single patient suffered or suffered more” because of the allegedly prolonged treatment times.
“These physicians were persuaded that the harmful effect of chemotherapy in the alleged instances would be reduced by giving smaller doses over a longer period of time,” Murphy said.
He said the case involved “billing and documentation issues” and he noted that both physicians continue to practice and weren’t excluded from federal medical payment programs.
This case was prosecuted by Assistant U.S. Attorney Benjamin S. Schecter and investigated by the HHS inspector general and the Kentucky attorney general’s Medicaid Fraud and Abuse Control Unit.
Stephanie Collins, a spokeswoman for the U.S. attorney’s office, said the settlement already has been paid.
The settlement is one of several reached this year in false billing cases in Kentucky.
King’s Daughter Medical Center in Ashland last week agreed to pay $40.9 million to the government to settle claims that it made millions of dollars by falsely billing Medicaid and Medicare for unnecessary heart procedures.
Claim
A whistleblower alleged the clinic diluted a chemo drug in order to increase the treatment times by a factor of three or more and bill more to Medicaid and Medicare.
Written by Andrew Wolfson and published at The Courier-Journal, June 4, 2014.
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