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E-town chemotherapy group agrees to $3.7 million payment

Settlement resolves allegations that Elizabethtown Hematology and Oncology, PLC (EHO) and its owners have agreed to pay more than $3.7 million to resolve allegations that they extended chemotherapy treatment times for their patients to maximize reimbursements and inappropriately billed office visits for infusion therapies.
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By Allison Gardner Martin and Stephanie Collins

Attorney General Jack Conway, along with David J. Hale, U.S. Attorney for the Western District of Kentucky, and the Office of Inspector General for the U.S. Dept. of Health and Human Services (OIG), announced Tuesday that Elizabethtown Hematology and Oncology, PLC (EHO) and its owners have agreed to pay more than $3.7 million to resolve allegations that they extended chemotherapy treatment times for their patients to maximize reimbursements and inappropriately billed office visits for infusion therapies.


This case was investigated by Attorney General Conway's Medicaid Fraud and Abuse Control Unit and the OIG. It was prosecuted by the U.S. Attorney's Office for the Western District of Kentucky.

"We take very seriously our obligation to hold accountable those who put profits ahead of patient care," Attorney General 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."

According to the settlement agreement, from Jan. 2005 through Dec. 2010, the United States and Commonwealth of Kentucky allege that the owners of EHO, Dr. Rafiq Ur Rahman and Dr. Yusuf K. Deshmukh, billed Medicaid, Medicare, TRICARE, and the Federal Employee Health Benefit Program (FEHBP) for unnecessary office visit evaluations at the same time patients were receiving chemotherapy or other types of infusion treatments. The United States and Commonwealth of Kentucky contend that EHO did this by improperly billing evaluation and management codes.

"Manipulating treatment protocols and lengthening infusion times to increase reimbursement reflect an extraordinary lack of regard for patient welfare and the integrity of our health care system," said David J. Hale, U.S. Attorney for the Western District of Kentucky. "This settlement will end these unacceptable practices and restore funds paid for improper claims during the relevant time period. Pursuing health care fraud is a priority of my Office and the Dept. of Justice. We will continue to work with the Dept. of Health and Human Services to pursue medical providers who engage in improper conduct and overbill government health care programs."

"Improper and unnecessary services cost the taxpayers millions of dollars each year and drains our nation's health care system," said Derrick L. Jackson, Special Agent in Charge of the OIG's regional office in Atlanta. "The OIG will continue to aggressively pursue false claims cases that return much needed dollars to government health care programs."

Some of the allegations covered by the settlement were raised in a lawsuit filed against EHO and its owners under the whistleblower provisions of the federal False Claims Act. In part of his lawsuit, Dr. Ijaz Mahmood alleged that EHO developed written protocols that increased chemotherapy infusion times by a factor of three or more beyond generally recognized standards of medical practice. Dr. Mahmood alleged that EHO prolonged these chemotherapy infusion times for longer than was medically necessary in order to inflate billings.

In addition to the $3.7 million payment, EHO and Dr. Deshmukh entered into a three-year Corporate Integrity Agreement with the OIG. The agreement requires enhanced accountability and wide-ranging monitoring activities conducted by both internal and independent external reviewers.


This story was posted on 2014-06-05 04:00:56
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