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According to the Department of Justice press release, a Maryland nuclear cardiologist and his two companies double billed for myocardial perfusion studies, also known as nuclear stress tests. A federal court in the District of Columbia has entered a $17 million judgment against the three in a False Claims Act (“FCA”) healthcare lawsuit.

Health and Human Services’ Office of the Inspector General apparently found this case itself, without the help of a whistleblower. I wrote recently about the problems that Medicare is going to face given recent, extreme budget cuts for OIG. This case is precisely the type that will go undetected as OIG ramps down its enforcement efforts due to deep budget cuts. As OIG loses its ability to fight fraud, we are going to become more and more dependent on whistleblowers to keep Medicare and Medicaid from getting swindled. I am an attorney who represents whistleblowers, so I know that we have many brave souls in this country who will blow the whistle on fraud, sometimes at extreme cost to their careers. At the same time, the amount of Medicare and Medicaid fraud is overwhelming. Combining cases brought with and without whistleblowers, DOJ says it has recovered $ 10.7 billion for healthcare fraud since 2009. Such a large recovery is great news for taxpayers, but it is a drop in the bucket given that an estimated $60 billion is being swindled from Medicare yearly.

According to the allegations in the FCA lawsuit, the doctor and his companies were double billing for nuclear stress tests that the doctor performed on patients. The myocardial perfusion study has two parts — a “stress” portion and a “rest” portion — which can be done in one day or which can be spread over two days. Regardless of whether the doctor does the test on one day or two, he is only allowed to submit one bill for both parts – in other words, the two parts must be billed as a single test. According to the Government, however, Dr. Malik, however, was billing the phases separately so that he got paid double the amount he should have.

The Government also accused the doctor of a practice called “unbundling.” When a healthcare provider “unbundles” a charge, it bills separately for a number of procedures or medications that should be included in the main bill. According to the federal allegations, the doctor was billing separately for items that were already included in the reimbursement for the nuclear stress test itself, such as “intravenous injections, drug infusions, 3D rendering and drug administration.” The Government also said that Dr. Malik had been using inappropriate billing codes, presumably billing for procedures more expensive than the nuclear stress tests he actually was conducting.

The U.S. Attorney for the District of Columbia, Ronald C. Machen, Jr., pointed out that medical overbilling ultimately results in “the rising cost of health care for all Americans”, because it “fraudulently divert[s] critical resources from government health care programs.”

It was unclear how much of the money the doctor would be able to pay. Machen said that the Government would do “everything in our power to obtain every cent” of the money owed.

According to DOJ lawyers, the federal Government, the Maryland Attorney General’s office, and the A.G. for the District of Columbia, jointly investigated the medical overbilling case. They filed suit against Dr. Istiaq Malik, his P.C. and another company he owned, Advanced Nuclear Diagnostics.