A whistleblower suit filed this week in a U.S. District Court in Pennsylvania alleges that cardiologists from two medical practices in the state defrauded Medicare by participating in illegal kickback schemes and performing unnecessary cardiac, vascular, and interventional procedures between 2001 and 2005.
A copy of the complaint filed in the U.S. District Court for the Western District of Pennsylvania and obtained by AuntMinnie.com names as defendants Dr. Richard Petrella, Dr. Robert Ferraro, Dr. Charles Furr, Dr. Timothy Trageser, and Dr. Donald Zone. It also names two medical practices -- Medicor Associates and an affiliate, Flagship Cardiac, Vascular, and Thoracic Surgery (CVTS) -- as well as the University of Pittsburgh's Hamot Medical Center.
The suit, filed under the False Claims Act by the U.S. and a cardiologist colleague of the defendants, Dr. Tullio Emanuele, alleges that the doctors and the institutions set up an illegal kickback scheme. Hamot entered into a series of contracts with Medicor, Flagship CVTS, and other physicians to pay kickbacks and to engage in unlawful relationships with physicians to generate patient referrals, the complaint states.
The complaint charges that Hamot sought to maximize its income from the procedures, looked for physicians with high procedure volumes, and "offered payment to them in the guise of sham contracts for medical directorships or other similar personal service arrangements," paying Medicor and Flagship $525,000 per year in addition to funding six directorships for the defendant physicians in cardiology, electrophysiology, cardiac surgery, etc., at $75,000 each annually. But the actual purpose of the contracts was illegal payment for the patient referrals, according to the complaint.
In addition, beginning in 2001 Hamot submitted false claims to Medicare and received reimbursements for medically unnecessary procedures, and by doing so "compromised the health of their patients and placed them at increased risk of injury and death," the complaint states.
Emanuele, who worked with the defendants and was in a position to review the procedures and records, became suspicious after noticing high rates of interventional procedures among some physicians. In one case, defendant Trageser allegedly performed a catheterization on an asymptomatic patient who had a false-negative result on a stress test. In another case, he allegedly performed a catheterization on a patient with chest pain even though the pain was inconsistent with angina.
The compensation scheme puts the defendants in violation of Medicare antikickback statutes aimed at preventing payment for referrals, and the Stark law, which prohibits Medicare claims based on patient referrals to physicians who have financial relationships with hospitals.
