Aug 09

Update on Recent Physician Prosecutions

From the American Health Lawyers Association (www.healthlawyers.org) authored by Judd Harwood, Esquire (Balch & Bingham LLP, Birmingham, AL), and David Ivers, Esquire (Mitchell Blackstock Ivers & Sneddon PLLC, Little Rock, AR)

Maryland Cardiologist Convicted for Inserting Unnecessary Cardiac Stents

A federal jury in Baltimore, MD, convicted cardiologist, John McLean, MD, fifty-nine years old, on six healthcare fraud offenses on July 26, 2011, for inserting unnecessary cardiac stents, ordering unnecessary follow-up tests, and falsifying medical records to justify the stents.

From at least 2003 to May 2007, McLean performed cardiac cathertizations and implanted unnecessary stents in more than 100 patients at Peninsula Regional Medical Center, according to the U.S. Department of Justice (DOJ). He then falsely recorded the existence of lesions observed during the procedures to justify the stents and the claims he submitted to Medicare and Medicaid. In addition, McLean ordered his cardiac patients to undergo medically unnecessary follow-up tests, including cardiolite stress tests, echocardiograms, and EKGs.

McLean faces a maximum sentence of ten years in prison for healthcare fraud and five years in prison for each of five counts of making false statements related to healthcare matters. Sentencing is scheduled for November 10, 2011. The government is also seeking forfeiture of $711,583 in proceeds from the billings.

The case was investigated by DOJ and Office of Inspector General. The case was tried by the U.S. Attorney's Office for the District of Maryland.

California Oncologist Sentenced to Prison for Billing for Cancer Medications That Were Never Provided

An Orange County, CA, oncologist was sentenced on July 25, 2011, to eighteen months in federal prison for submitting bills for cancer medications that were never provided.

U.S. District Judge Cormac J. Carney sentenced Glen R. Justice, MD, sixty-six years old, of Corona del Mar, after Justice pleaded guilty to five counts of healthcare fraud. Justice operated the Pacific Coast Hematology/Oncology Medical Group in Fountain Valley, CA. He billed for injectable cancer medications when patients never received them. In some cases where patients did receive medications, Justice upcoded claims by billing for more expensive injectable medications than were actually provided.

The medications involved were Neulasta, Neupogen, Procrit/Epogen/Aranesp, and Neumega. According to the U.S. Attorney's Office, the fraudulent billing occurred between 2004 through October 2009, despite Justice being advised about thee issue and subjected to a search warrant at his office in November 2006.

Improper billings amounted to between $400,000-$1 million. Insurers he billed included Medicare, Tricare, the Federal Employees Health Benefit Program, and Blue Cross and Blue Shield of California. The judge ordered Justice to pay $1 million in restitution.

The prosecution resulted from an investigation by the Federal Bureau of Investigation, U.S. Department of Health and Human Services Office of Inspector General, Internal Revenue Service Criminal Investigation Division, and U.S. Department of Defense Office of Inspector General.

Washington Oncologist and Wife Indicted for Twenty Counts of Healthcare Fraud

Alfred Hongleung Chan, MD, sixty-three years old, and his wife, Judy Yuan Chan, sixty-two years old, both of Lakewood, WA, were indicted by a federal grand jury for twenty counts of healthcare fraud, obstruction of justice, and money laundering. Alfred Chan was also indicted on two counts of making false statements. The indictment was unsealed in July.

According to the indictment and the civil litigation, Alfred Chan would make patient treatment notes on individual slips of paper that were given to his nurse. The notes specified the amount of drugs to be provided to a specific patient. After the nurse provided the drugs to patients by injection or infusion, the slips of paper were returned to Alfred Chan who shredded them. The doctor then made entries into a "superbill" form, ostensibly recording the amount of medications the patients had received. However, he allegedly recorded more medication administered than actually received by the patient, and inflated the time spent administering the medication. Judy Chan allegedly prepared the bills for Medicare and other government and private healthcare programs using the inflated amounts, which substantially increased the amount of money paid to the Chan clinic for medication. The government alleges the scheme resulted in inflated payments to the clinic in the amount of $1.7 million.

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