Physicians to pay $2 million for improper billing

A group of 10 physicians must repay $2 million for improperly billing for heart surgeries performed while the doctors were out of the country.

The U.S. Department of Justice (DOJ) and the Florida Attorney General’s Office announced the settlement with Florida Cardiology P.A. to resolve allegations of violations of the False Claims Act. The settlement comes as part of a whistleblower lawsuit that alleged Florida Cardiology submitted false claims for payment to Medicare, Medicaid, the Tricare military health care program, and the Federal Employee Health Benefits Program.

According to DOJ and U.S. Attorney’s Office in Florida, Sandeep Bajaj, MD, and Karan Reddy, MD, caused the practice to bill for more intravascular stents than were actually inserted into patients. Bajaj also billed for radiofrequency ablations that he did not perform and that, in some cases, were not performed by a qualifying provider.

They and eight other physicians caused Florida Cardiology to bill for procedures and services while they were outside the United States, which is allowed only in limited circumstances, according to the DOJ announcement.

“The defendants in this case attempted to rip off taxpayers—even going as far as billing Medicaid and Medicare for services they claimed were provided to patients in Florida while these doctors were actually out of the country. As a result of their brazen scheme and the great work of whistleblowers, my Medicaid Fraud Control Unit and our federal partners, these defendants will now pay for ripping off taxpayers,” Florida Attorney General Ashley Moody said in a news release.

DOJ announced the settlement ends a federal lawsuit filed in June 2022 in the U.S. District Court for the Middle District of Florida. Relators Derrick Graham and Jesse Frauehofer will receive $420,000 of the proceeds from the settlement, according to DOJ.

Florida Cardiology P.A. specializes in comprehensive adult heart care. The practice was established in 1983 and has 15 cardiologists, along with a physician assistant, nine nurse practitioners, and clinical support staff at 10 office locations around the greater Orlando, Florida, area, according to the practice website.