Bowling Green Facility to Pay Over $6M in 12-State Medicare Over-Billing Settlement

Sixteen Cardiology Practices to Pay a Total of $17.7M to Resolve False Claims Act Allegations Concerning Inflated Medicare Reimbursements

Edmonson Voice Report:
Sixteen separate cardiology practices and associated physicians, located across 12 states, have agreed to pay amounts totaling $17,761,564 to resolve allegations that they each violated the False Claims Act by over-billing Medicare for diagnostic radiopharmaceuticals, including $6.75M by Western Kentucky Heart & Lung Associates in Bowling Green.

In 13 states and the District of Columbia, Medicare Part B reimburses healthcare providers for diagnostic radiopharmaceuticals based on the provider’s acquisition cost. In those jurisdictions, Medicare’s contractors have published guidance explaining the reimbursement methodology and providers’ obligation to accurately report their invoice costs for diagnostic radiopharmaceuticals. The government alleged that the settling cardiology practices regularly reported inflated acquisition costs to Medicare for these drugs. In each of the settlements, the conduct occurred for at least a year, and in some instances, the conduct extended over a period of more than 10 years.

The settlement agreement with Western Kentucky Heart & Lung Associates in Bowling Green states "During the period between August 1, 2015 and August 31, 2022, Defendants submitted or caused to be submitted claims to Medicare that sought reimbursement for radiopharmaceuticals above Defendants' actual acquisition cost, thus resulting in excess payments by Medicare."

Out of the $6.75M from WKHL, $3.375M will be paid in restitution. The settlement also states that $4.5M is to be paid within three days of the agreement with the remaining $2.25M over five years plus 8.5% annual interest.

The settling medical practices and associated physicians have agreed to pay the following amounts:

• Western Kentucky Heart & Lung Associates PSC and Mohammed Kazimuddin ($6,750,000)
• Heart Clinic of Paris P.A. and Arjumand Hashmi ($2,600,000)
• Scranton Cardiovascular Physician Services LLC ($2,369,111)
• Shannon Clinic ($996,856)
• Edward W. Leahey M.D. Professional Association and Edward Leahey ($894,679)
• Metropolitan Cardiovascular Consultants LLC and Ayim Djamson ($846,888)
• Cardiology Center of New Jersey LLC, Mario Criscito, Frank Iacovone, and Sameer Kaul ($740,000)
• Clovis Cardiology Associates LLC and Mahamadu Fuseini ($600,000)
• Family Medical Specialty Clinic PLLC, Melecio Abordo, and June Abadilla ($409,594)
• James R. Higgins M.D. Inc. and James Higgins ($395,537)
• TrustCare Health LLC ($279,407)
• Taj Medical Inc. ($240,000)
• White River Diagnostic Clinic PLC, Margaret Kuykendall, and Seth Barnes ($234,490)
• Veinguard Heart & Vascular Center P.C. and Fareeha Khan ($195,000)
• Boulder Medical Center PC ($160,000)
• Wellspring Cardiac Care P.A. ($50,000).

Full Western Kentucky Heart & Lung Associates Settlement agreement below:

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