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Policy: Law

Ky. clinic settles FCA claims it extended chemotherapy treatment times

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Kentucky,Health Care,Law,Legal Newsline,Cancer
Conway

Conway

FRANKFORT, Ky. (Legal Newsline) – Kentucky Attorney General Jack Conway announced a settlement on Tuesday resolving allegations that a clinic extended chemotherapy treatment times to maximize reimbursements.

Under terms of the settlement, Elizabethtown Hematology and Oncology, PLC, and its owners will pay more than $3.7 million to resolve allegations of extending chemotherapy treatment times and inappropriately billing office visits for infusion therapies.

From January 2005 through December 2010, Dr. Rafiq Ur Rahman and Dr. Yusuf K. Deshmukh, the owners of EHO, allegedly billed Medicaid, Medicare, TRICARE and the Federal Employee Health benefit Program for unnecessary office visit evaluations at the same time that patients were receiving chemotherapy or other infusion treatment types.

EHO allegedly inappropriately billed through improper billing evaluation and management codes.

“We take very seriously our obligation to hold accountable those who put profits ahead of patient care,” Conway said. “I remain committed to recovering taxpayer money that is lost to health care fraud in Kentucky. I appreciate the efforts of my Medicaid fraud investigators who work every day to ensure that health care providers participating in this type of deceptive behavior are held accountable, and I am proud that our Medicaid Fraud Unit has been recognized as one of the most aggressive in the country.”

Some of the allegations were raised in a suit brought about under whistleblower provisions of the federal False Claims Act. Dr. Ijaz Mahmood alleged in that suit that EHO developed written protocols that increased chemotherapy infusion times by a factor of three or more and that EHO prolonged the infusion times for longer than was medically necessary to inflate billings.

EHO and Deshmukh, in addition to the $3.7 million payment, also entered into a three year Corporate Integrity Agreement with the office of inspector general for the U.S. Department of Health and Human Services requiring enhanced accountability and wide-ranging monitoring activities by both internal and independent external reviewers.

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