A Florida cardiologist, Dr. Asad Qamar and his practice will pay $2 million, plus release any claim to $5.3 million in suspended Medicare funds, to resolve a lawsuit alleging that they improperly billed Medicare, Medicaid and TRICARE for medically unnecessary procedures, and paid kickbacks to patients by waiving Medicare copayments irrespective of financial hardship. Dr. Qamar also agreed to a three-year period of exclusion from participating in any federal health care program followed by a three-year Integrity Agreement with the Department of Health and Human Services Office of the Inspector General (HHS-OIG).
“Billing federal health programs for medically unnecessary procedures is unacceptable – not only does it waste taxpayer funds, but it also puts patients at risk,” said Principal Deputy Assistant Attorney General, Benjamin C. Mizer, head of the Justice Department’s Civil Division. “Today’s settlement evidences the Department of Justice’s firm commitment to protect public funds and to safeguard the well-being of federal health care program beneficiaries.”
The settlement resolves the government’s lawsuit claiming that Dr. Qamar billed Medicare, Medicaid and TRICARE for excessive, medically unnecessary and inadequately documented peripheral artery interventional services and related procedures. Many of the cardiovascular procedures for which Dr. Qamar billed Medicare and the other programs were not indicated by patients’ medical histories or records, or the severity of the patients’ symptoms.
The government also alleged that to help facilitate this false billing scheme, Dr. Qamar routinely and indiscriminately waived the 20 percent Medicare copayment, irrespective of the patient’s financial need. Medicare copayments assure that patients have an incentive to be smart healthcare consumers and avoid unnecessary procedures. By waiving the required copayments indiscriminately, Dr. Qamar induced patients to agree to unnecessary and invasive procedures and other services. Dr. Qamar’s illegal conduct made him the highest paid Medicare cardiologist in the country in 2012 and 2013.
“Patient safety is of paramount importance,” said U.S. Attorney A. Lee Bentley III for the Middle District of Florida. “When a doctor performs medically unnecessary and invasive procedures on Medicare patients, federal healthcare programs are defrauded and, more importantly, patients’ lives and wellbeing are recklessly put at risk. This case shows our office’s steadfast commitment to holding medical providers personally responsible for their actions.”
“When medical professionals act on greed to perform unnecessary, invasive procedures on Medicare and Medicaid patients, both patient health and taxpayer funds are compromised,” said Special Agent in Charge Shimon R. Richmond of HHS-OIG. “Our agents and investigators will continue to work hard with our law enforcement partners to ensure that health care providers who engage in such illegal behavior are held accountable.”
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $29.9 billion through False Claims Act cases, with more than $18.3 billion of that amount recovered in cases involving fraud against federal health care programs.