On June 4, 2013, a former cardiologist in Kentucky pleaded guilty to health care fraud for submitting a claim for an unnecessary cardiac stent procedure that was billed to Medicaid. The 51-year-old cardiologist admitted that he lied about the severity of his patient’s medical condition in order for the hospital where he performed the stent procedure to be reimbursed by Medicaid. The unnecessary stent procedure for which he pleaded guilty took place in February 2009; the hospital received $6,088 in payment for the procedure.
The hospital has repaid the federal government $256,800 for alleged false claims filed in 2009 and 2010 for the former cardiologist’s stent procedures performed in the hospital. The Kentucky cardiologist was the first to be prosecuted in Kentucky (and the third in the United States) for alleged health care fraud involving cardiac stents. The Kentucky cardiologist reached an agreement with the U.S. Attorney’s Office to serve a prison term between 30 and 37 months, which must be approved by a judge when he is sentenced on August 27, 2013.
The U.S. Attorney for the Eastern District of Kentucky stated after the guilty plea: “Both patients and the entities that pay for medical services trust that our physicians will accurately and honestly assess a patient’s medical condition. We will aggressively pursue any physician or provider that breaches this trust and places their own financial well-being ahead of the well-being of the patients.” Source
The cardiologist’s attorney stated that the cardiologist believed that the stent procedures that he performed were medically necessary and in the best interest of the patients but the cardiologist agreed to take responsibility for “not recording the proper data” in support of reimbursement for the stent procedures (Medicare and Medicaid standards for reimbursement for cardiac stent procedures require at least a 70% blockage of an artery with symptoms of blockage). The cardiologist admitted that he placed a stent in an artery that had substantially less than 70% blockage but he recorded in the medical records that the blockage was greater in order to obtain payment from Medicaid.
Cardiologists performing unnecessary stent procedures on patients who should not have been subjected to stents not only cost the health care system thousands of dollars per procedure, but also cause harm to their patients who received the unnecessary stents. Most patients who receive stents must be on blood thinners for the rest of their lives, which come with their own risks and side effects. Patients who undergo stent procedures may suffer serious or even fatal complications during the procedures or as a result of the stents, which would have been prevented if the unnecessary stent procedures were avoided. Not to be under-estimated is the cost in terms of patients’ confidence in their health care providers when they read that some physicians put their own financial interests above their patients’ health.
If you or a loved one had a stent procedure in the United States that may have been unnecessary or resulted in complications that may be due to medical negligence, you should promptly consult with a local medical malpractice attorney in your U.S. state who may agree to investigate your stent claim for you and file a stent malpractice claim on your behalf, if appropriate.
Click here to visit our website or telephone us on our toll-free line (800-295-3959) to be connected with stent malpractice lawyers in your state who may be able to assist you with your stent claim.
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