A Fresno heart doctors group has agreed to pay $1.2 million to resolve allegations that they improperly performed and billed federal and state health care programs for medically unnecessary diagnostic procedures, the office of U.S. Attorney Phillip A. Talbert announced Tuesday.
The settlement by Cardiovascular Consultants Heart Center and its physicians – Drs. Kevin Boran, Michael Gen, Rohit Sundrani, Donald Gregory and William Hanks – resolves allegations that between Jan. 1, 2010, and Dec. 31, 2015, the heart center submitted claims for cardiovascular nuclear imaging that were not medically necessary or reasonable.
The total number of patients involved has not been determined, said Lauren Horwood, a spokeswoman for the Attorney General’s office. The investigation arose from a complaint made to the U.S. Health and Human Services Office of Inspector General hotline, she said.
The doctors deny the allegations and the settlement is not an admission of wrongdoing.
The government alleged that the doctors automatically scheduled patients for nuclear stress tests on an annual basis without seeing them first to confirm that the procedure was necessary. 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 procedures based on false positive results, the government said.
The risk of a nuclear stress test is only justified if it is medically necessary, the government said. And a Centers for Medicare & Medicaid Services Local Coverage Determination prohibited the use of the tests as a screening procedure.
Patric Hooper, a Los Angeles lawyer who represents the center and doctors, said “it was with great reluctance that these doctors chose to resolve this dispute by paying the government any money.” It is not unusual for there to be debate between doctors and Medicare over what health services are reasonable and necessary, Hooper said. “Our position is these are anything but routine screening tests,” he said. “A lot of their patients benefited very much by having their cardiac disease monitored through this nuclear imaging.”
Hooper said the doctors followed patients with longstanding cardiac disease for years, and they wanted to get the results of nuclear imaging scans in advance so they could review them and then sit down with patients to discuss their situations. The doctors have longstanding careers in Fresno and are skilled cardiologists who get hard cases, he said. The Cardiovascular Consultants Heart Center website says “for more than 25 years we’ve provided the highest level of care utilizing the latest technology.”
“These doctors continue to be excellent doctors and this is anything but a fair resolution,” Hooper said. But, he said, “Rather than spend hundreds of thousands of dollars litigating over this difference of opinion in the courts, our clients believed it was in the patients’ and their best interests to put this debate behind them by agreeing to a financial settlement based on projected costs of defending themselves in court. Our clients admitted no wrongdoing of any type in the settlement papers and no lawsuit or other action was ever filed by the government against them. They can now continue to devote their full attention to taking care of their patients.”