Heart Failure

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There are multiple treatments available to help patients that have been diagnosed with heart failure. Angioplasty and stents are at the top of the list for unblocking blood vessels and improving circulation. A well respected cardiologist in Kentucky billed Medicare for invasive heart procedures – many of them involving stents – that were not medically necessary. (Now it looks like he may be headed for a stint in prison.)

The renowned cardiologist has a vascular center named after him at the hospital where he worked. Court documents showed that he billed Medicare for more heart procedures than any other cardiologist in Kentucky (he earned $2.6 million in one year)and was ranked fifth in the nation for stent procedures paid for by the government healthcare program. (Another statistic he may not be too proud of is that he is also the third cardiologist in the state to be convicted of health care fraud.)

The cardiologist justified the unneeded heart procedures by falsifying his patients’ medical records, exaggerating their medical condition to qualify for government payments. (One plaintiff alleges that the doctor implanted multiple unnecessary stents over four years and now he suffers from allergic reactions to the stents’ polymers including hives, joint pain and swelling in his throat.)

Ten cardiologists testified on behalf of the U.S. and after a seven-week trial plus four days of deliberations, the jury convicted him for performing unnecessary heart procedures involving coronary stents and diagnostic catheterizations. He is facing a maximum of 20 years for health care fraud and up to five years for making false statements.

While the hospital where he was employed agreed to pay the government $40.9 million to resolve civil allegations that millions of dollars were made by falsely billing federal health care programs for medically unnecessary heart procedures, this man must also pay for his illegal actions. When he became a doctor, he agreed to uphold ethical standards and to do no harm to his patients. (It’s time for this cardiologist to examine his own heart and motivations for stealing from a government program that is intended to care for, and not harm, patients.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Eminent KY heart surgeon guilty of health fraud,” published by the Courier-Journal on October 31, 2016.

In the latest in a series of such cases in Kentucky, an eminent cardiologist in Ashland, for whom his hospital’s vascular center is named, has been convicted of health care fraud for performing invasive heart procedures on patients who did not need them.

From 2006 to 2012, Dr. Richard E. Paulus at King’s Daughters Medical Center billed Medicare for more heart procedures than any other cardiologist in Kentucky and was fifth in the nation in the amount paid by Medicare for stent procedures.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.