Long Island Physicians Pay $1.1 Million To Resolve Civil Fraud Allegations That They Provided And Billed For Unnecessary Medical Testing
Dr. Vikas Desai (Desai), the principal of Desai MD, P.C. d/b/a East Islip Family Care (EIFC), and Dr. Robert Maccone, a physician who was previously affiliated with EIFC, have entered into separate civil settlement agreements in which they have collectively agreed to pay the United States a total of $1,120,299 to resolve allegations that they submitted claims to Medicare for nerve conduction studies (NCVs) that were not medically necessary.
The settlement was announced by Kelly T. Currie, Acting United States Attorney for the Eastern District of New York; Scott Lampert, Special Agent-in-Charge of New York’s Office of the Inspector General for the Department of Health and Human Services (HHS-OIG); and Scott Rezendes, Special Agent-in-Charge of New York’s Office of Personnel Management, Office of the Inspector General, Field Operations (OPM).
The government alleged that Dr. Desai, Dr. Maccone, and the late Dr. Edmond Ross – all of whom were at various times affiliated with EIFC – ordered and rendered NCVs on patients for whom those studies were not medically necessary. NCVs involve the electrical stimulation of a patient’s nerves and muscles to measure the conduction speed of electric impulses and proper nerve and muscle function. Because NCVs involve the administration of low levels of electric current, or shocks, to a patient, the tests can be uncomfortable and even painful. Specifically, the government alleged that Drs. Desai, Ross, and Maccone ordered the subject NCV studies despite the lack of apparent indications in the medical charts, and that when NCV studies were indicated, they were not performed in conformance with those indications (e.g., patients with arm complaints were inexplicably given leg NCV studies). The government contended that there was no medically necessary reason for the subject studies, and that accordingly, defendants falsely submitted thousands of claims for those studies to Medicare and OPM.
Dr. Desai has agreed to settle the government’s allegations regarding medically unnecessary billings made by both Dr. Desai and the late Dr. Ross from January 1, 2009 (the year that Dr. Desai purchased the EIFC from Drs. Ross and Maccone) to December 31, 2012, for the sum of $302,208.00. Dr. Maccone has agreed to settle the government’s allegations regarding his medically unnecessary billings from November 1, 2007 to December 31, 2011, for the sum of $818,091.33.
The investigation that led to the settlements began after Rosemarie Hennessey, a receptionist at EIFC, filed a complaint on behalf of the United States in the Eastern District of New York. The government recently intervened in that matter and is resolving it consistent with the terms set forth herein. Under the federal False Claims Act, a private individual who has uncovered fraud against the federal government may file a suit in federal court on behalf of the United States. If the United States is successful in resolving those claims, the individual who filed the complaint may receive a share of the recovery.
“We are committed to battling health care fraud, especially in situations where the allegations involve doctors making testing and treatment decisions that do not benefit patients, only themselves, and harm the Medicare program,” stated Acting United States Attorney Currie. Mr. Kelly extended his grateful appreciation to HHS-OIG and OPM for their assistance in this matter.
The government’s case was handled by Assistant U.S. Attorney Erin E. Argo, with assistance from Affirmative Civil Enforcement Auditor Emily Rosenthal.
E.D.N.Y. Docket No. 10-CV-3851