Tennessee Cardiologist to Pay $1.15 Million to Settle Allegations That He Performed Medically Unnecessary Heart Procedures

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Cardiologist Dr. Elie H. Korban will pay $1.15 million to resolve False Claims Act allegations that he billed

Medicare and Medicaid for medically unnecessary cardiac stent placements, the Justice Department announced today.  Korban owns Delta Clinic, with offices in Jackson, Tenn., and Lexington, Tenn., and has privileges at Jackson-Madison County General Hospital and Regional Hospital of Jackson, both in Jackson, Tenn.

 
“ Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and can harm patients ,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery.  “ Protecting public funds and safeguarding Medicare beneficiaries continues to be a Department of Justice priority .”

 

Cardiac stents are mesh tubes placed in coronary arteries of patients to keep their arteries open during the treatment of coronary heart disease.  The government contends that, from January 1, 2005, through December 31, 2008, Korban placed cardiac stents in Medicare and Medicaid patients when the stents were not medically necessary .  The government also claims that Korban improperly billed Medicare for work performed by substitute doctors when he was available to perform the services himself. 

 
“This case is one of many that underscores our commitment to holding accountable those who would cheat the health care system for their own personal profit,” said U.S. Attorney for the Western District of Tennessee Edward L. Stanton III.  “We will continue to vigorously protect citizens from schemes that damage the ability of health care providers and patients to participate in a system free of false claims and dishonesty.”

 
As part of the settlement, Korban entered into an Integrity Agreement with the Department of Health and Human Services Office of Inspector General intended to deter wrongful conduct in the future.  The agreement requires enhanced accountability and monitoring activities to be conducted by both internal and independent external reviewers. 

 

“Too many recent frauds involve medically unnecessary heart stents,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services Office of Inspector General region including Tennessee.  “Providers are warned that they can be aggressively investigated and held accountable for falsely billing federal health programs.”

 

Assistant Attorney General Delery thanked the Department of Health and Human Services Office of Inspector General, the Tennessee Bureau of Investigation, the U.S. Attorney’s Office for the Western District of Tennessee and the Commercial Litigation Branch of the Justice Department’s Civil Division for the collaboration that resulted in the settlement. 

 

The allegations resolved by the settlement were first raised in a lawsuit filed against Korban under the qui tam, or whistleblower, provisions of the False Claims Act.  The Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery.  As part of the settlement, the whistleblower, Dr. Wood M. Deming, will receive a share of the settlement amount.  Deming’s share has not been determined. 

 
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $17 billion through False Claims Act cases, with more than $12.2 billion of that amount recovered in cases involving fraud against federal health care programs.

 
The case is captioned United States ex rel. Wood M. Deming  v. Jackson-Madison County General Hosp., et al., Case No. 07-1116-BBD (W.D. Tenn.).  The claims settled by this agreement are allegations only, and there has been no determination of liability.  

News Source : Tennessee Cardiologist to Pay $1.15 Million to Settle Allegations That He Performed Medically Unnecessary Heart Procedures

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