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U.S. Intervenes in Two Medicare Fraud Lawsuits

(CN) - The U.S. government joined two whistleblower lawsuits against a Florida cardiologist accused of defrauding Medicare by padding bills and performing unnecessary procedures.

Dr. Asad Qamar has been described as one of the top Medicare billers in the country. He was sued by two whistleblowers -- a former employee and the director of a medical management company -- in separate lawsuits filed in 2011 and 2014. The cases remained under seal until last week, when the Justice Department decided to join them.

The plaintiffs, who sued Qamar in Federal Court in Ocala and Tampa, Fla., allege the doctor and his Institute for Cardiovascular Excellence billed Medicare for unnecessary procedures and waived co-pays and deductibles in order to convince patients to agree to expensive tests and procedures.

The lawsuits claim Dr. Qamar performed thousands of unnecessary procedures on the government's dime. In addition, it alleges Dr. Qamar billed Medicare for more costly procedures when he actually completed less-expensive ones - a scheme known as "upcoding."

"Performing medically unnecessary procedures puts patients at risk and contributes to the soaring costs of health care," said Acting Assistant Attorney General Joyce R. Branda for the Justice Department's Civil Division in a written statement. "Today's action evidences the Department of Justice's efforts both to safeguard federal health care program beneficiaries and to protect public funds."

The first case was filed on July 11, 2011, by an unnamed employee and alleges Dr. Qamar and ICE repeatedly performed "unnecessary cardiac tests including high invasive, and therefore particularly dangerous, cardiac catheterizations."

A cardiac catheterization involves putting a long tube into a blood vessel and threaded into the heart while the doctor performs various diagnostic tests to determine how much plaque is inside the body's arteries.

The suit also claims stress tests and ultrasounds were routinely conducted even though the patients had none of the underlying symptoms requiring them.

The second lawsuit was filed on June 17, 2014, by Holly Taylor, the former director of client services at Partners in Practice, a Sarasota-based medical billing company. Dr. Qamar hired the company to look over ICE's Medicare billing practices in 2008 and Taylor took over the account in 2010.

Taylor claims she immediately became concerned about the necessity of many of Dr. Qamar's procedures and the wrong codes assigned to them. In addition, the suit states, Dr. Qamar told patients to ignore invoices from PIP containing co-pay amounts and deductibles due. This was done, Taylor maintains, so patients would not question the high costs of the unnecessary tests and allow ICE to maximize profits. The company warned the doctor about the issues, but he never corrected them. PIP stopped providing billing services in 2011.

In the lawsuit, Taylor claims Dr. Qamar "defrauded the United States and the state of Florida of tens of millions of dollars."

In one instance, Taylor says, a patient came to Dr. Qamar with blockages in her heart and both legs. Instead of sending the patient to a specialist for the life-threatening heart problem, Dr. Qamar put a stent in the woman's leg and scheduled her for another operation for the other leg. But before she could receive the second procedure, the woman died of complications from the leg stent.

"Physicians should make medical decisions on the basis of their patients' needs," said U.S. Attorney A. Lee Bentley III for the Middle District of Florida in a press release. "Performing medically unnecessary procedures solely to line a physician's pockets strains our nation's health care system, and can also jeopardize the health and safety of patients. Fighting Medicare and other health care fraud is one of our office's most important priorities."

Both suits are looking for millions in damages. Under the False Claims Act, the whistle-blowing plaintiffs can receive a portion of the recovered money. According to the Department of Justice, the government has recovered more than $23 billion through False Claims Act cases - nearly $15 billion involving federal health care programs.

When news reports surfaced last April about the amount of Medicare reimbursements to ICE, Dr. Qamar defended the payments, saying he serves a population that depends heavily on Medicare. Although an outpatient facility, he told reporters, he performs many of the same procedures as hospitals, so costs are higher.

ICE has offices in Ocala and surrounding towns, including the Villages - Florida's largest senior retirement community with more than 50,000 residents.

The Justice Department says another case against Dr. Qamar is expected to be unsealed soon.

Taylor is represented by Rafael Nobo of the Nobo Law Group in Miramar, Florida. John Doe is represented by Miami Beach-based attorney Jonathan Kroner.

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