Dinesh Shah Pays To Resolve False Claims Act Allegations

Cardiologist Dinesh Shah Pays $2 Million To Resolve False Claims Act Allegations Relating To Excessive Testing

DETROIT (STL.News) An Oakland County Cardiologist, Dinesh M. Shah, M.D. and his practice, Michigan Physicians Group, P.C. (MPG) have paid the United States $2 million to resolve allegations that they violated the False Claims Act by knowingly billing federal healthcare programs for diagnostic testing that was either unnecessary or not performed.  MPG is a Michigan professional corporation with primary offices located in Berkley and Livonia, Michigan, and with administrative offices, labs, and testing sites at other locations within the metropolitan Detroit area.  Shah is a practicing cardiologist and the sole owner of MPG.

This settlement resolves allegations that from 2006 to 2017, Shah and MPG knowingly billed government programs, including Medicare, Medicaid, and TRICARE, for unnecessary diagnostic testing.  The investigation focused on the provision of a group of diagnostic tests, which included Ankle Brachial Index and Toe Brachial Index tests, known as ABI/TBIs, which were routinely performed on patients without first being ordered by a physician and without regard to medical necessity.  The ABI compares blood pressure in the ankle to blood pressure in the arm to determine how well blood is flowing from the heart to the feet.  The TBI is an additional measure to assess blood pressure readings at the toes.

The investigation also focused on the provision of unnecessary Nuclear Stress Tests.  The United States alleged that Shah was routinely ordering, and MPG was providing, unnecessary Nuclear Stress Tests to some patients.  During a Nuclear Stress Test, a small amount of radioactive tracer is injected into a vein, after which it is detected by a special camera that produces images used to evaluate blood flow to the heart.

This settlement comes after a years-long investigation by the Office of Inspector General for the United States Department of Health and Human Services and the Defense Health Agency acting on behalf of the TRICARE Program. The State of Michigan Attorney General’s Office participated in the settlement as the State of Michigan was a named plaintiff in one of the cases.

“Subjecting patients to unnecessary testing in order to fill one’s pockets with taxpayer funds will not be tolerated.  Such practices are particularly concerning because overuse of some tests can be harmful to patients,” said Acting U.S. Attorney Saima Mohsin. “With these lawsuits and the accompanying resolution, Dr. Shah and Michigan Physicians Group are being held to account for these exploitative and improper past practices.

“Physicians commit to providing and billing for only medically necessary services when they choose their profession and participate in federally funded health care programs,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & human Services, Office of Inspector General – Chicago Region.  “To deviate from that commitment and potentially place their patient’s health and safety at risk as well as limited tax payer resources is unacceptable.  The OIG will continue to work with our federal, state and local partners to ensure that patients and tax payer dollars are protected.”

In addition to the civil settlement agreement, Dinesh Shah and MPG simultaneously entered into an Integrity Agreement with the Office of Inspector General for the United States Department of Health and Human Services, which provides for some oversight of Shah and MPG’s billing practices for a three-year period.

The settlement resolves allegations originally brought in lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act by two separate whistleblowers, Arlene Klinke and Khrystyna Mala, both former employees of MPG.  The False Claims Act permits private parties to file suit on behalf of the United States and to share in any recovery.

The matter was handled by Assistant United States Attorneys Leslie Wizner and Lynn Dodge.

The two qui tam cases are docketed as United States ex rel. Arlene Klinke v. Dinesh Shah, M.D. and Michigan Physicians Group, Civil Action No. 10-cv-10726 (E.D. MI), and United States and State of Michigan ex rel. Khrystyna Mala v. Michigan Physicians Group, P.C. Dinesh Shah, M.D. Alka Shah, M.D., Rita Shah, M.D. and Tatiana Shcherbich, Civil Action No. 12-cv-10732 (E.D. MI).

The claims resolved by the settlement are allegations only; there has been no determination of liability.

SOURCE: USDOJ.Today