Justice Dept. Sues Doctor Paid Richly by Medicare
By REED ABELSON and JULIE CRESWELL
JAN. 5, 2015
One of the nation’s top-billing doctors, a cardiologist who collected more than $18 million in payments from Medicare in 2012, has been accused by the federal government of performing unnecessary procedures on patients.
The Justice Department announced on Monday that it had joined two whistle-blower lawsuits filed against the doctor, Dr. Asad Qamar, and his medical group, the Institute for Cardiovascular Excellence in Ocala, Fla.
The lawsuits accuse Dr. Qamar of billing Medicare for unnecessary operations to treat arteries in the limbs that — like those in the heart — can become narrowed because of the buildup of plaque. Federal officials also accused Dr. Qamar of paying kickbacks to patients by waiving their portion of the bill, regardless of their ability to pay.
“Dr. Qamar practices under the highest medical and ethical standards,” Gregory W. Kehoe, a lawyer with the firm of Greenberg Traurig, which is representing him, said. “Any claims to the contrary are unsubstantiated, and the doctor will defend himself vigorously against these baseless allegations.”
As top Medicare billers have come under scrutiny, federal officials in recent years have brought several prominent cases against cardiologists and hospitals, accusing them of performing unnecessary procedures like inserting stents in coronary arteries. Dr. Qamar’s billings raised questions last year when Medicare released information about how much the program paid individual physicians. He received more than $18 million in payments from Medicare, according to the government’s data, more than three times the amount given to the next highest-paid cardiologist.
At the time the information about his billings was released in April, Dr. Qamar defended the high level of payments, although he said he had been under regulatory scrutiny for more than a year.
“Just looking at the sheer volume of work and billings from a single physician is not a sign of wrongdoing,” he said in an article in The New York Times about the controversy over his payments.
He explained that his medical practice, which has a caseload of 23,000 patients, handles procedures, like opening blocked arteries in the legs of older patients, that would normally be performed by a hospital in many other states and therefore resulted in the large payments.
The release of the data had some political overtones. Dr. Qamar was a major contributor to the Democratic Party and had reached out to his political contacts in Washington about Medicare’s review of his billings. In one of the whistle-blower lawsuits, a former consultant who had been engaged in 2010 to review Medicare billings for Dr. Qamar’s practice said she became aware that he and others in the group routinely waived Medicare co-payments so that a patient would not question the high cost of the procedures being performed. As a result, Dr. Qamar and the group billed for an “unrealistically high percentage of expensive procedures,” according to the lawsuit.
The Institute for Cardiovascular Excellence was also having problems being reimbursed for a number of its services, and the lawsuit says it was already under investigation by a Medicare contractor.
The outside consultant also noted that Dr. Qamar and the physician practice performed a high number of procedures on vessels outside the heart. The lawsuit says that only a small number of patients actually require surgical procedures, but that under Dr. Qamar’s care, nearly all patients who received a diagnostic scan also underwent surgery.
In at least one instance, according to one of the lawsuits, a patient who actually needed treatment for a blockage in her heart had a stent put in one leg and was scheduled for a similar procedure in the other leg. The patient died of complications from the first stent procedure, the lawsuit claims.
The outside consultant also discovered that patients who were scheduled for a specific procedure would often undergo additional, unplanned diagnostic imaging. Dr. Qamar would explain he had done so because he was “already in there,” the lawsuit claimed. The suit claims there were high numbers of patients who were scheduled for heart procedures but also had imaging done of other vessels.
A version of this article appears in print on January 6, 2015, on page B4 of the New York edition with the headline: Justice Dept. Sues Doctor Paid Richly by Medicare. Order Reprints