Florida Cardiology, P.A. And 10 Physicians Agree To Pay $2 Million To Settle False Claims Act Liability

Orlando, FL – United States Attorney Roger B. Handberg announces today that Florida Cardiology, P.A., Sandeep Bajaj, Karan Reddy, and eight other physicians have agreed to pay the United States and the State of Florida $2 million to resolve allegations that they violated the False Claims Act by submitting inflated claims to Medicare and Medicaid and for billing while the physicians were outside the United States.

The United States and the State of Florida previously intervened in a whistleblower lawsuit against Florida Cardiology and the physician-defendants on June 27, 2022. The lawsuit and settlement relate to the submission of claims that were improperly billed or performed, and submitted or caused to be submitted by Florida Cardiology, Sandeep Bajaj, Abbas Ali, Karan Reddy, Claudio Manubens, Milan Kothari, Saroj Tampira, Sayed Hussain,Raviprasad Subraya, Harish Patil, and Edwin Martinez.

According to the lawsuit and settlement agreement, Dr. Bajaj and Dr. Reddy caused Florida Cardiology to bill for more intravascular stents than were actually inserted into patients; Dr. Bajaj caused Florida Cardiology to bill for radiofrequency ablations that were not performed by him and in some instances, were not performed by a qualifying provider; and all ten physician-defendants caused Florida Cardiology to bill for procedures and services while they were outside the United States.  According to the Complaint in Intervention, except in limited circumstances, providers cannot bill for services while outside the United States. According to the settlement agreement, Florida Cardiology submitted these false claims for payment to Medicare, Medicaid, TRICARE, and the Federal Employee Health Benefits Program.

“Fraud schemes represent a tangible threat to our public health programs,” said U.S. Attorney Roger Handberg. “This civil settlement demonstrates our continuing commitment to the integrity of these programs, and to holding providers accountable for the truth of what they represent in their claims.”

“The defendants in this case attempted to rip off taxpayers—even going as far as billing Medicaid and Medicare for services they claimed were provided to patients in Florida while these doctors were actually out of the country. As a result of their brazen scheme and the great work of whistleblowers, my Medicaid Fraud Control Unit and our federal partners, these defendants will now pay for ripping off taxpayers,” stated Florida Attorney General Ashley Moody.

“Health care professionals participating in Medicare and Medicaid are expected to abide by rules meant to protect patients, and to properly bill the programs on which their patients rely. Physicians who put financial gain above the well-being of patients and the integrity of federal health care programs will be held accountable for their actions,” said Special Agent in Charge Omar Pérez Aybar with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “In coordination with our law enforcement partners, HHS-OIG will continue to investigate such allegations to protect the beneficiaries of all HHS programs.”

“We commend the U.S. Attorney’s office, the Florida MFCU, HHS Office of Inspector General, and the Defense Criminal Investigative Service for their commitment to safeguarding the TRICARE Health Plan,” stated the Defense Health Agency. “Their efforts protect taxpayer dollars to ensure our service members, veterans, and their families continue to receive the highest degree of medical care.”

“False claims threaten the integrity of the Federal health care programs and waste American taxpayer funds,” said Conrad J. Quarles, Deputy Assistant Inspector General for Investigations, OPM OIG. “We applaud our partners at the Department of Justice for holding providers accountable for fraudulent billing practices.”

The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by Relators Derrick Graham and Jesse Frauenhofer.  The Relators sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting private citizens to sue on behalf of the United States for false claims and to share in the recovery. The Act also allows the United States to intervene and prosecute the action. The Relators will receive $420,000 of the proceeds from the settlement with the Defendants.

This settlement resulted from a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida, the Florida Office of the Attorney General Medicaid Fraud Control Unit (“MFCU”), the HHS Office of Inspector General, and the Defense Criminal Investigative Service. Assistant United States Attorney Jeremy R. Bloor and Florida MFCU’s Senior Assistant Attorney General Matthew Vitale led the investigation.

The case is captioned United States and the State of Florida ex rel. Graham and Frauenhofer v. Florida Cardiology, P.A., et al, Case No. 18-cv-1444-Orl-RBD-LHP. The settlement resolves the United States and the State of Florida’s claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.