TUESDAY, APRIL 25, 2000(202) 616-2777
WWW.USDOJ.GOVTDD (202) 514-1888
CARDIAC SURGERY GROUP WILL PAY $500,000
TO RESOLVE CLAIMS OF FALSELY BILLING MEDICARE FOR ADDITIONAL SURGEONS
WASHINGTON, D.C. -- A Newark, New Jersey medical partnership of cardiac surgeons specializing in complex heart bypass and transplant surgeries has agreed to pay $500,000 to the United States to settle claims that the practice submitted false claims to Medicare for the services of additional surgeons, the Justice Department announced today.
The government alleged that from 1991 to 1995, the Newark Cardiovascular and Thoracic Surgery Group routinely submitted claims to Medicare seeking reimbursement for both a primary surgeon and an "Assistant at Surgery" for heart bypass and other cardiothoracic surgeries performed at Newark Beth Israel Hospital. The claims were submitted regardless of whether a second surgeon provided the assistance or was even present for the operation. Medicare statute and regulations state that in order to qualify for reimbursement an "Assistant at Surgery" must "actively assist the physician in charge of a case in performing the surgical procedure."
"This settlement reflects the government's continued commitment to pursuing health care fraud and false claims for Medicare reimbursement," said David W. Ogden, Acting Assistant Attorney for the Civil Division. In addition to the monetary settlement, three physicians affiliated with the Group entered into five year integrity agreements with the Office of the Inspector General and Department of Health and Human Services to settle administrative claims.
The settlement concludes an investigation undertaken by the Federal Bureau of Investigation's Newark, New Jersey field office and the United States Department of Justice in Washington, D.C.