Spokane Area Cardiologist, Dr. Romeo Pavlic, to Pay $300,000 Resolving Alleged False Health Care Claims

Spokane, WA – Today, the United States Attorney’s Office (USAO) for the Eastern District of Washington announced a settlement agreement with Dr. Romeo Pavlic and various companies he owns. The settlement resolves allegations that for years Dr. Pavlic, a Spokane-area cardiologist, falsely billed Medicare and Medicaid by repeatedly and falsely claiming to have provided services and tests to vulnerable patients when in fact he had not.

The settlement agreement, which was entered into with both the United States as well as the State of Washington, calls for Dr. Pavlic to pay a total of $300,000 within 5 days- $279,190 to the United States and $20,810.00 to the State of Washington for its portion of the Medicaid payments that Dr. Pavlic allegedly took through his knowingly false billing.

According to the settlement agreement, between January 1, 2010, and December 31, 2013, Dr. Pavlic was ostensibly providing medical services and tests to the vulnerable adult residents of Lakeland Village in Medical Lake. Lakeland Village is a State operated facility that provides training, education, and healthcare for about 250 individuals with developmental disabilities. People who receive services at Lakeland Village have profound physical and mental disabilities.

The United States alleges that Dr. Pavlic would conduct “cardiac clinics” at Lakeland Village approximately once per month. These “cardiac clinics” would run two to three hours, during which time Dr. Pavlic would see approximately 20-35 residents, scheduled at five to ten minute intervals; at times seeing as many as 40-55 residents, according to allegations.

It was during those “cardiac clinics” that Dr. Pavlic allegedly billed for services not provided and tests not conducted. Specifically, Dr. Pavlic would routinely bill Medicare and Medicaid for a longer and more detailed patient evaluation than he actually provided, according to the allegations in the settlement agreement. In addition, Dr. Pavlic would routinely bill Medicare and Medicaid for a complete echocardiogram when in fact he was only providing a limited echocardiogram, according to the allegations in the settlement agreement. The United States also alleges that, at least as to providing supposedly full echocardiograms Dr. Pavlic was warned in writing in December of 2012 that while other cardiologists in his area billed for full echocardiograms on approximately 12% of their Medicare/Medicaid patients, Dr. Pavlic was claiming to have done so on over 90% of his Medicare/Medicaid patients. Despite this clear warning that his billing practices were suspect, Dr. Pavlic continued to bill for the full tests which were not provided, according to the United States’ allegations.

Joseph H. Harrington, Acting United States Attorney for the Eastern District of Washington, said: “This settlement agreement resolves some very serious allegations very favorably for the tax payers.” Harrington went on to state that, “doctors, especially those providing services to our most vulnerable citizens, must not violate their duty to the tax payers who are funding those needed services. If doctors do violate that duty they can expect, at a minimum, to pay back the tax payers much more than they took.”

“When doctors exploit vulnerable patients and bill for procedures that were never performed, they violate the basic trust that patients and taxpayers extend to healthcare providers,” said Special Agent in Charge Steven J. Ryan of the U.S. Department of Health and Human Services Office of Inspector General. “We will continue to aggressively pursue those who engage in health care fraud.”

This case was investigated by the United States Attorney’s Office’s Health Care Fraud Investigator, the Office of Inspector General for the U.S. Department of Health and Human Services, and the Medicaid Fraud Control Unit of the Washington Office of the Attorney General.

A copy of the settlement agreement is attached.