published on November 28, 2017 - 11:19 AM
Written by The Business Journal Staff

A cardiology clinic with offices in Fresno and Clovis will pay a seven-figure settlement regarding allegations of billing health care programs for medically unnecessary testing.

According to a press release from U.S. Attorney Phillip A. Talbert, Cardiovascular Consultants Heart Center (CVC Heart Center) and its shareholder physicians—Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory and Dr. William Hanks—will pay $1.2 million to resolve federal and state False Claims Act allegations that they improperly performed and billed federal and state health care programs for medically unnecessary cardiovascular diagnostic procedures.

The settlement resolves allegations that CVC Heart Center submitted claims for cardiovascular nuclear imaging (nuclear stress tests) between 2010 and 2015 that were not medically necessary or reasonable. CVC physicians are alleged to have automatically scheduled patients for these tests on an annual basis without seeing the patients to see if it was necessary beforehand.

A nuclear stress test is an expensive procedure that exposes patients to a significant amount of radiation through the injection of radioactive dyes, as well as to the risk of invasive procedure based on false positive. The use of these tests as a screening procedure was prohibited by a Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination.

“This risk is only justified if the nuclear stress test is medically necessary,” the release said.

According to the news release, the claims settled by this agreement are allegations only, and there has been no determination of liability.

Edward Baker, a U.S. Attorney, pursued the case in coordination with the Department of Health and Human Services Office of Inspector General and Office of General Counsel, the FBI and the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

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