Donald Gregory, and Dr. William Hanks — will pay $1.2 million to resolve federal and state False Claims Act allegations that they improperly performed and billed federal and state health care programs for medically unnecessary cardiovascular diagnostic procedures, U.S. Attorney Phillip A. Talbert announced.The settlement resolves allegations that between January 1, 2010, and December 31, 2015, CVC Heart Center submitted claims for cardiovascular nuclear imaging (nuclear stress tests) that were not medically necessary or reasonable. It is alleged that the CVC physicians automatically scheduled patients for nuclear stress tests on an annual basis without seeing the patients beforehand to confirm that the procedure was necessary. A nuclear stress test is an expensive procedure that exposes patients to a significant amount of radiation through the injection of radioactive dyes, as well as to the risk of invasive procedures based on false positive results. This risk is only justified if the nuclear stress test is medically necessary. A Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination prohibited the use of nuclear stress tests as a screening procedure.
This case was pursued by Assistant U.S. Attorney Edward Baker through a coordinated effort with the Department of Health and Human Services Office of Inspector General and Office of General Counsel, the Federal Bureau of Investigation, and the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.
The claims settled by this agreement are allegations only, and there has been no determination of liability.
Source: DOJ
