South Miami Hospital has agreed to pay the government $12 million to settle healthcare fraud allegations from a whistleblower lawsuit that claimed it charged federal healthcare programs for medically unnecessary electrophysiology studies and other cardiology services.

James A. Burks M.D. and James D. Davenport M.D. were the South Miami Hospital whistleblowers who brought the allegations to the government’s attention by filing a qui tam lawsuit alleging the hospital submitted false claims for reimbursement based on medically unnecessary procedures provided by Dr. John R. Dylewski.

According to the Justice Department, Dr. Dylewski and South Miami Hospital performed and billed for a number of unnecessary cardiac procedures, including echocardiograms, electrophysiology studies, head upright tilt tests, and treatments of arrhythmia by ablation, cryoablation or by implanting an electronic device.

An electrocardiogram tests the action of the heart using ultrasound waves, which provide a visual display that can be used to diagnose or monitor heart disease. An electrophysiology study is a minimally invasive procedure to test the heart’s electrical conduction system.

According to the allegations, these cardiac procedures were conducted for the sole purpose of increasing the amount of reimbursements paid by Medicare and Medicaid. By performing these unnecessary procedures, the cost to government healthcare programs was increased significantly.

“Performing medically unnecessary heart procedures is shocking to the conscience,” said Shimon R. Richmond, HHS-OIG Miami Special Agent in Charge. “Conducting cardiac catheterizations purely for profit, not patient care, seriously breaches the “do no harm” commitment physicians pledge. Together with our law enforcement partners, we will seek out, stop these practices and protect the Medicare patients who are victimized by physicians participating in these schemes.”

The South Miami Hospital whistleblowers, who claimed to have personal knowledge of the fraud committed by Dr. Dylewski and the hospital, filed a whistleblower lawsuit under the False Claims Act, which allows for private citizens to sue on the government’s behalf and share in any recovery.

Dr. Burks is a board-certified vascular surgeon that practiced at South Miami Hospital in 2003. A board-certified cardiologist, Dr. Davenport worked at South Miami Hospital from 2010 to 2014, where he served on a number of peer review committees.

Both South Miami Hospital whistleblowers will share a reward totaling roughly $2.75 million.

The case is captioned United States of America ex. rel. James A. Burks, M.D. and James D. Davenport, M.D. v. John R. Dylewski, M.D., et al., Case No. 14-CV-22079 (S.D. Fla.). The claims that were settled in this whistleblower lawsuit are allegations only, and there has been no determination of liability.

Unnecessary Cardiac Procedures Becoming a Serious Problem

According to recent data, Medicare spends roughly $583 billion every year on cardiac services. Part of the reason cardiology has become a hotbed for fraud and abuse is because the procedures are often expensive, and the way doctors are compensated creates incentive for them to perform more procedures.

Take heart stenting as an example, which costs federal health care agencies $2.4 billion in average per year: A doctor gets paid less than $250 to discuss alternative treatments to heart stenting, or the risks involved with stent implantation. The same doctor receives on average four times that amount to implant a heart stent. This has the effect of rewarding physicians for the volume of work they perform rather than the quality of care they are providing.

“Are these doctors going to get bigger paychecks at the end of the month for doing more of these procedures? That may be an uncomfortable question to ask but it’s something patients should wonder about,” says Dr. David Jones, author of “Broken Hearts: The Tangled History of Cardiac Care.”

Healthcare Fraud Whistleblower Attorneys

Schemes involving cardiac care are not only dangerous because they bilk money from taxpayers, they also put patient health in serious danger. For those working within the industry, if you see providers offering medically unnecessary cardiac procedures, you need to report it. By coming forward and blowing the whistle on health care fraud, you are not only protecting the integrity of our government health care system, you are protecting the health and wellbeing of the patients in your charge.

If you have questions about filing a healthcare fraud claim, contact the whistleblower attorneys at Baum, Hedlund, Aristei & Goldman. We can help you understand your rights and walk you through the process of filing a claim. If your claim is successful, you could see a whistleblower reward of between 15 and 25 percent of any funds recovered on the government’s behalf.

Give us a call at 800-827-0087 or contact us for more information on whistleblower claims.

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