Fraud in Kentucky Healthcare

March 28th, 2014 by Attorney Dan Carman

Government investigations into potential healthcare fraud in this state are active and ongoing. King’s Daughters Medical Center (KDMC) in Ashland has been under investigation by the Department of Justice (DOJ) since 2011 to determine whether the heart doctors there were implanting stents in patients when the stents weren’t really needed. With a rate of 27 out of every 1,000 Medicare patients at KDMC receiving at least one stent in 2010—3.5 times higher than the national average—it was just a matter of time before DOJ focused its investigative attention on KDMC.

Earlier this month, two lawsuits were filed in state court alleging that KDMC doctors performed unnecessary stent-related procedures in order to get paid by Medicare. Those lawsuits were filed by Louisville-based and Texas-based law firms that, according to KDMC spokesman Tom Dearing, “persistently solicited our cardiac patients through multiple channels.” The lawsuits were filed against the hospital, several medical practices, and a physician (now retired) for whom KDMC’s heart and vascular center was named.

Earlier this year, St. Joseph London Hospital settled with the federal government to the tune of $16.5 million after investigations were launched concerning allegations that Medicare and Kentucky Medicaid claims were fraudulently submitted for unnecessary stents and pacemakers, as well as unneeded coronary artery bypass grafting. The settlement also covered allegations that the hospital entered into a sham agreement with a clinic in the London area that referred patients to St. Joseph, a violation of the federal anti-kickback law. One of the doctors at the clinic is now serving 30 months at a federal prison in Texas after he pled guilty to federal healthcare fraud charges.

The investigation of St. Joseph’s practices started after a whistleblower complaint was filed by three Lexington cardiologists, who will be splitting $2.4 million from the settlement. The hospital’s president, Greg Gerard, said it agreed to the settlement without admitting any wrongdoing in order to avoid the expense and uncertainty of litigation. However, the feds are continuing a criminal investigation into the hospital’s arrangement with the clinic and the whistleblower lawsuit.

The feds are in it to win in the fight against healthcare fraud. DOJ is working diligently with the Department of Health and Human Services to stamp out these white-collar crimes. Since 2007, the two federal departments have coordinated a multi-agency team of federal, state, and local investigators in the Medicare Fraud Strike Force and the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat fraud.
If you work in the healthcare industry and find yourself caught up in a task force or HEAT investigation into fraud, or on the receiving end of a whistleblower or other civil or class action lawsuit brought by persons who believe you’ve committed fraud, you must take the matter seriously. You could lose your license to practice, or find yourself having to pay tens of thousands of dollars in fines and restitution, not to mention having to serve prison time.

You need to talk with Dan Carman, Lexington healthcare fraud attorney, concerning the case against you. Dan is admitted to practice law throughout Kentucky, in the United States District Courts for the Eastern and Western Districts of Kentucky, and in the Sixth Circuit of the United States Court of Appeals. Dan has the experience you’re going to need to work your way through federal court. Call him today at (859) 685-1055, or go online and fill out the free and confidential get help now form on his website.