FOR FURTHER INFORMATION CONTACT
AUSA VICKIE E. LEDUC or
MARCIA MURPHY at 410-209-4885
AUGUST 22, 2007
FOR IMMEDIATE RELEASE
POTOMAC CARDIOLOGIST AGREES TO PAY $476,000 AND ENTER INTO AN INTEGRITY AGREEMENT TO SETTLE FALSE BILLING CLAIMS
Baltimore, Maryland - Pradeep Srivastava, M.D., age 48, a cardiologist practicing in Greenbelt and Oxon Hill, Maryland, has agreed to pay the United States $476,000 to settle claims that he fraudulently billed Medicare and the Federal Health Employees Health Benefits Program (“FEHBP”) over a three and a half year period, announced United States Attorney for the District of Maryland Rod J. Rosenstein.
According to the settlement agreement, the government contends that Srivastava committed multiple billing abuses from November 1, 1999 to May 31, 2003, including billing for services not rendered; “unbundling,” a practice where a provider bills for multiple component parts of a procedure as opposed to billing one comprehensive CPT code; and upcoding, or billing for a service at a higher level than that which was furnished.
United States Attorney Rod J. Rosenstein said, “Doctors who file false claims for federal health benefits must be held accountable for their conduct. This settlement achieves that goal by recovering damages under the False Claims Act and protecting the integrity of the federal health care program through a monitored integrity agreement.”
Specifically, Srivastava billed for services not rendered, by falsely billing Medicare and the FEHBP for a combined left and right heart catheterization, yet he only performed the left heart catheterization.
Srivistava “unbundled” claims, by falsely billing Medicare and the FEHBP (1) for the introduction of the catheter in addition to billing for the cardiac catheterization which included the introduction of the catheter; (2) for transcatheter biopsies at the same time that he billed for a cardiac catheterization, stent placement, or angioplasty even though the biopsy generally was part of these procedures; (3) for radiological interpretation of transcatheter therapy at the same time that he billed for a cardiac catheterization, stent placement, or angioplasty even though radiological interpretation was generally part of these procedures; (4) for all five subparts of percutaneous transluminal coronary angioplasty (PTCA) in addition to billing for the PTCA itself; (5) for various component codes associated with the insertion of pacemaker in addition to billing for implanting the pacemaker itself; and (6) for an angioplasty and stent placement of the same vessel, even though the services billed for an angioplasty were already included in services billed for stent placement.
Srivastava upcoded claims for evaluation and management services by falsely billing Medicare and the FEHBP: (1) the highest level evaluation and management code regardless of how brief or limited in scope the consultation actually performed; (2) for initial inpatient consultation when Srivastava was not the physician who performed the consultation; (3) when there was no documented request for a consultation; and (4) as if Srivastava were providing an opinion or advice to another physician’s patient when the individual was already a patient of Srivastava’s medical practice prior to the patient’s hospitalization.
The defendant has denied these allegations.
In addition to the monetary settlement, Srivastava has agreed to enter into a five year integrity agreement with the Office of the Inspector General, Department of Health and Human Services. The integrity agreement imposes compliance measures and ongoing monitoring to ensure the integrity of claims submitted by Srivastava to federal health care programs.
Enacted during the Civil War, the False Claims Act is the government’s primary civil tool to combat fraud and abuse in federal programs and procurement. The Act allows the government to recover triple the amount of its actual damages, plus a civil penalty of $5,500 to $11,000 for each false claim.
United States Attorney Rod J. Rosenstein commended the investigative work performed by the Department of Health and Human Services Office of the Inspector General and the Office of Personnel Management Office of Inspector General. Mr. Rosenstein also thanked Assistant U.S. Attorney Thomas F. Corcoran, who handled the case.