By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On December 7, 2016, a Miami-area hospital will pay the federal government about $12 million to resolve allegations that it violated the False Claims Act (FCA) by submitting false claims to federal health care programs for medically unnecessary cardiac procedures, the U.S. Department of Justice (DOJ) said.
The allegations against South Miami Hospital stem from procedures allegedly performed by Dr. John R. Dylewski while he worked for the hospital. “Performing medically unnecessary heart procedures is shocking to the conscience,” Shimon R. Richmond, the U.S. Health and Human Services’ (HHS) Office of Inspector General’s (OIG) special agent in charge, said in a statement. “Conducting cardiac catheterizations purely for profit, not patient care, seriously breaches the ‘do no harm’ commitment physicians pledge.”
Two Whistle Blowers Add to the Mix.
Two whistle blowers, Dr. James A. Burks and Dr. James D. Davenport, brought the suit to light and stand to receive about $2.75 million of the settlement. Dr. Burks is a vascular surgeon who started working at South Miami Hospital in 2003 and Dr. Davenport is a cardiologist who was active in various peer review committees at the hospital between 2010 and 2014.
Both whistle blowers claimed to have personal knowledge of Dr. Dylewski and the hospital performing a number of unnecessary cardiac procedures for the sole purpose of increasing the amount of reimbursements paid to the hospital and its doctors by Medicare the DOJ said. According to the two whistleblowers, the alleged wrongdoing was known throughout the hospitals’ corporate hierarchy, including top executives, department officers, medical division chiefs and members of peer review committees. Additionally, both whistleblowers claim to have witnessed “repeated and continuing instances” of the improper medical and billing practices.
Dr. Dylewski, who no longer works at the hospital, was not a party to the settlement. Click here to read the press release on the suit from the DOJ.
To learn more about FCA suit, click here to read one of my prior blogs on a similar case.
Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.
Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Kennedy, John. “Florida Hospital To Pay $12M To Settle FCA Claims.” Law360. (December 7, 2016). Web.
Lincoff, Nina. “BREAKING: South Miami Hospital to pay $12M to settle false claims allegations.” South Florida Business Journal. (December 7, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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