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Suit: Millions Paid For Unneeded Nuclear Tests

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The federal government has stepped in on the side of a cardiologist-turned-whistle-blower who filed a False Claims Act lawsuit alleging that a Mobile, Alabama, health system and its affiliates gave its doctors bonuses for ordering unnecessary nuclear imaging and other tests.

Altogether, the lawsuit says, Diagnostic Physicians Group (DPG), Infirmary Health System, and related entities submitted more than $521 million in unlawful charges to Medicare, Medicaid, TRICARE, and other government health health-care payers from 2004 through 2010. Those fraudulent claims, according to the suit, generated payments of more than $18.6 million.

The suit says the more tests the doctors ordered, the greater the bonus. Some doctors, it says, falsified records to justify unnecessary tests. For example, the suit says, some doctors said patients had complained of chest pains when medical charts said they hadn’t.

Christian Heesch, MD, a cardiologist who worked for DPG from 2003 until he was fired in July 2011, filed the original lawsuit immediately after his firing. The U.S. Department of Justice announced Monday that it was taking over the suit. Christ Coumanis, an attorney representing Heesch, said:

We’re real pleased the government intervened in the complaint, and we stand ready to help in any way possible.

Coumanis was quoted by Lagniappe, a biweekly newspaper in Mobile. Dr. Heesch could receive a percentage of any money the government recovers.

The lawsuit alleges that while at DPG, Dr. Heesch protested what he considered to be unnecessary tests that, among other things, subjected patients to unnecessary radiation. The suit says he was wrongfully discharged about six weeks after he began a formal request for records.

The suit also alleges self-referral violations of the Anti-Kickback Statute and the Stark Law.

In a statement to the Mobile Press-Register and its online affiliate, AL.com, D. Mark Nix, president and CEO of Infirmary Health, denied any wrongdoing, saying:

Tests performed at the Clinic were medically necessary to provide appropriate care for our patients and in compliance with applicable requirements.

Related CME seminar (up to XX AMA PRA Category 1 credits™): National Diagnostic Imaging Symposium™


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