Kentucky health system, cardiologist to pay $3M for alleged scheme targeting Medicare and Medicaid
Appalachian Regional Healthcare (ARH), a Kentucky-based health system with 13 hospitals, and one of its cardiologists have agreed to pay a total of $3.03 million to settle civil allegations that they submitted improper claims to Medicare and Medicaid.
Cardiologist Padubidri Chandrashekar, MD, is at the center of these claims. Chandrashekar and ARH allegedly billed Medicare and Kentucky’s Medicaid program for multiple diagnostic catheterization procedures that were not medically necessary. The United States alleged that Chandrashekar “did not have sufficient documentation” to support the procedures and billed for “unnecessary appointments” before they were performed. Chandrashekar has also been accused of seeing that improper claims were submitted for ambulance transfers connected to these patients.
ARH agreed to pay approximately $2.88 million to resolve the civil allegations related to improper billing. In a separate agreement, ARH and Chandrashekar agreed to pay approximately $150,000 to resolve their False Claims Act liability.
“This matter arose from ARH’s self-disclosure of false or noncovered claims. Because ARH self-reported the conduct to the government, it was able to resolve its False Claims Act liability for only 1.5 times the amount of monetary loss caused by its false claims,” according to a prepared statement from the United States Attorney’s Office of the Eastern District of Kentucky. The False Claims Act establishes liability for three times the amount of loss suffered by the government.
The claims brought forward by the United States are only allegations; as a part of the settlement agreements, there has been no determination of liability or guilt.
The U.S. Department of Health and Human Services, Office of Inspector General, Kentucky Attorney General’s Office of Medicaid Fraud and Abuse Control and the Affirmative Civil Enforcement section of the U.S. Attorney’s Office all worked together to investigate the case against ARH and Chandrashekar.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.