Between January 1, 2013, and December 31, 2019, Dr. Ashish Pal allegedly submitted false claims to federal health care programs for medically unnecessary ablations and vein stent procedures, according to the settlement.
The United States Department of Justice (DOJ) alleged that the surgeon performed the procedures on veins that did not qualify for treatment under the standards of the industry. Dr. Pal was also accused of misrepresenting patient medical records to justify the surgeries, including overstating the degree of reflux and diameter of veins and falsely documenting patient symptoms.
In many instances, the ablations were allegedly performed by one or more ultrasound technicians outside of their scope of practice, according to the DOJ.
“Physicians are expected to perform procedures only when they have a legitimate medical basis to do so,” said Acting Assistant Attorney General Brian M. Boynton for Justice Department’s Civil Division. “The department will pursue those who waste taxpayer funds and subject patients to unwarranted medical care.”
Acting U.S. Attorney Karin Hoppmann of the Middle District of Florida added that their office would continue holding people accountable who abuse the nation’s healthcare programs at the expense of taxpayers.
To prevent the alleged abuses from reoccurring, Dr. Pal and his medical practice Interventional Cardiology & Vascular Consultants entered into a detailed, multi-year integrity agreement with the U.S. Department of Health & Human Services Office of Inspector General (HHS-OIG) that includes training and reporting requirements as week as claims reviews conducted by an independent review organization.
“When physicians enrich themselves by performing medically unnecessary procedures on Medicare and Medicaid beneficiaries, they threaten their patients’ health and divert taxpayer funds meant to pay for necessary care,” said Special Agent in Charge Omar Pérez Aybar of HHS-OIG. “We will continue to work hard with our law enforcement partners to ensure that health care providers who engage in such abusive behavior are held accountable.”
In the event that the contract’s terms are breached, there are provisions for stipulated penalties and the possible exclusion from federal health programs such as Medicare and Medicaid, according to the DOJ.
“The healthcare providers within the Military Health System are committed to patient satisfaction and take seriously their obligation to ensure great outcomes by providing the highest-quality care,” said Director Lt. General Ronald J. Place, M.D. of the Defense Health Agency (DHA). “We are grateful to the U.S. Department of Justice for working to maintain that trust by ensuring medical providers continue to put their patients’ needs and safety first.”
In 2014, The New York Times reported that two Florida doctors who received the nation’s highest Medicare reimbursements in 2012 used their connections to the Democratic Party to help defend themselves against suspicions of fraud. At the time, the state was home to 28 out of the top 100 physicians who received the largest payments.
Dr. Asad Qamar, an interventional cardiologist from Ocala, was the second-highest-paid physician by Medicare and the first highest-paid cardiologist—receiving $18.2 million. Second in the specialty was Dr. Pal, who received $4.5 million. He told the Times then that his billing “was entirely appropriate and fair.”
