Heart Center to pay large settlement

From The Business Journal:

Cardiology Clinic Settles for $1.2M Over Unnecessary Testing Claims

A cardiology clinic with offices in Fresno and Clovis will pay a seven-figure settlement regarding allegations of billing health care programs for medically unnecessary testing.

According to a press release from U.S. Attorney Phillip A. Talbert, Cardiovascular Consultants Heart Center (CVC Heart Center) and its shareholder physicians—Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory and Dr. William Hanks—will pay $1.2 million to resolve federal and state False Claims Act allegations that they improperly performed and billed federal and state health care programs for medically unnecessary cardiovascular diagnostic procedures.

The settlement resolves allegations that CVC Heart Center submitted claims for cardiovascular nuclear imaging (nuclear stress tests) between 2010 and 2015 that were not medically necessary or reasonable. CVC physicians are alleged to have automatically scheduled patients for these tests on an annual basis without seeing the patients to see if it was necessary beforehand.

A nuclear stress test is an expensive procedure that exposes patients to a significant amount of radiation through the injection of radioactive dyes, as well as to the risk of invasive procedure based on false positive. The use of these tests as a screening procedure was prohibited by a Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination.

“This risk is only justified if the nuclear stress test is medically necessary,” the release said.

According to the news release, the claims settled by this agreement are allegations only, and there has been no determination of liability.

If you're concerned about the compliance and billing practices of your medical practice, let REED TINSLEY, CPA guide you in ensuring adherence to regulations and optimizing your practice's financial health.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.