Manhattan U.S. Attorney Settles Civil Fraud Claims Against Vascular Surgery Clinic And Surgeon For Fraudulently Billing Medicare For Nonreimbursable Vascular Surgery Procedures
Preet Bharara, the United States Attorney for the Southern District of New York, and Scott Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s (“HHS-OIG”) New York Region, announced today that the United States has settled civil fraud claims under the False Claims Act against MATTOO & BHAT MEDICAL ASSOCIATES, P.C. (“MBPC”) and DR. FENG QIN (“DR. QIN”) related to MBPC’s submission of fraudulent claims for reimbursement by Medicare for vascular surgical procedures that are not covered under Medicare. In connection with the settlement, which was approved by U.S. District Judge Louis L. Stanton on May 1, 2015, the defendants agreed to pay a total of $1,150,000 to resolve their liabilities.
Manhattan U.S. Attorney Preet Bharara said: “As they admitted, Mattoo & Bhat Medical Associates, P.C., and Dr. Feng Qin performed and billed Medicare for surgery procedures in violation of Medicare’s billing rules. We will continue to work to protect the public’s money from providers who try to skirt Medicare billing rules for their own profit.”
HHS-OIG Special Agent in Charge Scott Lampert said: “Performing invasive procedures that do not qualify for Medicare reimbursement and then billing Medicare for them undermines the financial integrity of the Medicare program. This settlement is another example of OIG’s commitment to protecting our beneficiaries and taxpayers from such abusive practices.”
According to the complaint filed in Manhattan federal court:
Patients with end-stage renal disease (“ESRD”), who are covered by Medicare, regularly require and receive dialysis treatments. Vascular surgeons may provide vascular access services to these patients, such as creation and maturation of fistulas, a port in the patient’s arm to obtain access to the patient’s circulatory system, through which dialysis is done. In addition, when clinically indicated, such surgeons may provide fistulagrams, a radiological procedure in which dye is injected into the patient’s vein or artery to visualize the port and surrounding blood vessels, and angioplasties, in which wires and balloons are inserted into veins or arteries that have narrowed in order to restore the patient’s blood flow. Routine monitoring of a dialysis patient’s access site, however, is typically done by the patient’s nephrologist and the dialysis nurses and technicians, who are reimbursed by Medicare for the ongoing monitoring and surveillance.
According to Medicare billing rules in New York State, monitoring of a dialysis patient’s access site does not require vascular surgery procedures, such as fistulagrams and angioplasties, and these procedures are not reimbursable unless the patient has specific clinical problems, such as significant difficulty receiving dialysis properly. Routinely performing fistulagrams and angioplasties where there is no supporting clinical indication is not reimbursable by Medicare. The rules also state that angioplasties are reimbursed by Medicare only if, in addition to the clinical findings required to support a fistulagram, there is evidence that the patient’s blood vessel has a restriction greater than 50% of the vessel’s diameter.
MBPC operated two office-based surgical offices in Manhattan and Queens, which operated under the trade name “AV Care,” from December 2010 to April 2012, and DR. QIN worked primarily at MBPC’s Manhattan location. AV Care’s patients were ESRD patients undergoing dialysis treatment. As a regular practice, AV Care routinely scheduled patients for fistulagrams and angioplasties as many as three months in advance, and MBPC surgeons, including DR. QIN, performed these fistualgrams as a matter of routine even if the patient presented without a clinical reason. Furthermore, from time to time, DR. QIN performed angioplasties on AV Care patients where the patient information and records did not support the presence of a restriction greater than 50% of the diameter of the patient’s blood vessel. MBPC wrongly billed Medicare for these procedures, which were excluded from Medicare coverage by the applicable rules.
As part of today’s settlement, MBPC and DR. QIN admitted that they regularly performed, and billed Medicare for, vascular surgery procedures done only for surveillance purposes, in violation of the Medicare billing rules. MBPC agreed to pay $1,000,000 and Dr. QIN agreed to pay $150,000 to resolve their respective liabilities for this conduct. In addition, MBPC and DR. QIN entered into integrity agreements with HHS-OIG, through which they agreed to implement certain compliance measures and submit to monitoring by HHS-OIG.
The case is being handled by the Office’s Civil Frauds Unit. Assistant United States Attorneys Rebecca C. Martin and Jean-David Barnea are in charge of the case.