Hematology clinic pays $3.73 million to settle Medicare overbilling case

Elizabethtown Hematology Oncology, PLC, and its owners have agreed to pay $3,739,325.41 to resolve allegations that they submitted or caused to be submitted false claims for payment to the Medicare, Medicaid, TRICARE – the health care program for Uniformed Service members, retirees and their families worldwide – and the Federal Employee Health Benefit Program (FEHBP) for extending the duration of chemotherapy infusion treatment to patients and inappropriately billing office visits for infusion therapy treatments, announced the Office of Inspector General of the Department of Health and Human Services and David J. Hale, United States Attorney for the Western District of Kentucky.

“Manipulating treatment protocols and lengthening infusion times to increase reimbursement reflect an extraordinary lack of regard for patient welfare and the integrity of our health care system. This settlement will end these unacceptable practices and restore funds paid for improper claims during the relevant time period,” stated David J. Hale, United States Attorney for the Western District of Kentucky. “Pursuing health care fraud is a priority of my Office and the Department of Justice. We will continue to work with the Department of Health and Human Services to pursue medical providers who engage in improper conduct and overbill government health care programs.”

According to the settlement agreement, the United States and Commonwealth of Kentucky contend that Dr. Rafiq Ur Rahman and Dr. Yusuf K. Deshmukh, owners of Elizabethtown Hematology Oncology, PLC (EHO), billed Medicare, TRICARE, FEHBP and Medicaid from January 1, 2005, through December 31, 2010, for unnecessary office visit evaluations at the same time patients were receiving chemotherapy or other types of infusion treatments. The United States and Commonwealth of Kentucky contend that EHO did this by improperly billing evaluation and management codes using Modifier-25 (allows for billing evaluation and management necessary prior to the performance of a procedure).

The United States and Commonwealth of Kentucky further contend that during a seven year period, between January 1, 2006 and December 31, 2012, Dr. Rahman, Dr. Deshmukh, and EHO unnecessarily and improperly extended the duration of chemotherapy infusion treatment times for their patients in order to improperly bill Medicare, TRICARE, FEHBP and Medicaid for those additional hours of chemotherapy infusion treatments.

Some of the allegations covered by today’s settlement were raised in a lawsuit filed against EHO and its owners under the qui tam, or whistleblower, provisions of the federal False Claims Act. United States ex rel. Dr. Ijaz Mahmood v. Elizabethtown Hematology et al., Civil Action No. 3:11-cv-376-H (WDKY). The False Claims Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the United States and share in any recovery. In part of his lawsuit, Dr. Mahmood alleged that EHO developed written protocols that increased chemotherapy infusion times by a factor of three or more beyond generally recognized standards of medical practice. Dr. Mahmood alleged that EHO prolonged these chemotherapy infusion times for longer than was medically necessary in order to inflate billings. Relator, Dr. Ijaz Mahmood, will receive $283,412.90 as part of today’s settlement.

In addition to the $3.7 million payment, EHO and Dr. Deshmukh entered into a three-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The agreement requires enhanced accountability and wide-ranging monitoring activities conducted by both internal and independent external reviewers.his settlement agreement is neither an admission of liability by Rahman and Deshmukh nor a concession by the United States and Commonwealth of Kentucky that its claims are not well founded.

This case was prosecuted by Assistant United States Attorney Benjamin S. Schecter and it was investigated by the Office of Inspector General for the Department of Health and Human Services and by the Kentucky Attorney General’s Medicaid Fraud and Abuse Control Unit.

Jeff Newman represents whistleblowers