DoJ intervenes in Tenn. suit of inappropriate use of cardiac services
A whistleblower suit filed by a Tennessee cardiologist has alleged that cardiologist Eli Hage Korban, MD, along with two Tennessee hospitals, engaged in fraudulent billing and overuse of medical services, and now the Department of Justice (DoJ) has stepped in. The current case adds to a slew of other similar cases surrounding the overutilization of stenting.

The court documents claim that Korban submitted false claims to Medicare, TriCare and Medicaid programs, and that these actions were “condoned” by James Moss, CEO of Jackson-Madison County General Hospital, Timothy Puthoff, CEO of the Regional Hospital of Jackson and radiologist Joel Perchik, MD.

The suit filed by Wood M. Deming, MD, a cardiologist at Regional Cardiology Consultants in Jackson, Tenn., alleged that “CEOs Moss and Puthoff, despite the advice and counsel of members of their respective hospitals’ medical staffs, chose to ignore blatant overutilization of cardiac medical services, including but not limited to cardiac sonography, scintigraphic stress imaging, angiography, angioplasty and stenting by Korban, shielding same from any scrutiny by the hospitals’ clinical quality improvement mechanisms.”

The suit filed in the U.S. District Court for the Western District of Tennessee Jackson Division stated that the defendants were connected in a “bilateral kickback and self-referral scheme violative of the Antikickback Statute,” and collected substantial government payments at the harm of the government and taxpayers.

Additionally, the documents stated that Moss, Puthoff and Perchik engaged in “bad-faith peer review of any physician who chose to oppose the hospitals’ drive for excess and inappropriately collected remuneration.”

Deming charged that Korban was involved in a plot where he ordered “numerous unnecessary diagnostic studies at the defendant hospitals.” The studies included, but were not limited to transthoracic echocardiography, scintigraphic stress imaging and transesophageal echo. The documents also allege that Korban ordered these tests on elderly nursing home patients and then subsequently ordered their transport by ambulance to the accused hospitals for unnecessary PCI procedures, diagnostic coronary angiography and other coronary and peripheral interventions.

“Korban also followed the same scheme in some cases with patients who were very young, in many cases in their twenties, who were at little, if any risk for heart disease,” Deming claimed. Despite the fact that many of these patients received negative stress imaging test results, the patients still underwent catheterization procedures.

“CEOs Moss and Puthoff, and Perchik were aware of, conspired with, condoned and encouraged Korban in his scheme for their own personal, professional and financial gain and that of their respective hospitals,” the documents stated.

These fraudulent claims are in direct violation of the False Claims Act, and the court documents state that the plaintiff will be entitled to civil penalties that equal between $5,000 and $10,000 for each fraudulent claim of Korban and the two hospitals.

In a court order dated June 2, Judge Bernice Bouie Donald, District Judge for the U.S. District Court Western District of Tennessee, stated that the U.S. will intervene with the court case and ordered the complaint to be served within 120 days. However, the U.S. will only intervene in part of the allegations, including the case against Korban.

The U.S. will not intervene with the part of the action that alleges claims against the other aforementioned defendants. The government will file its complaint within 60 days, according to a statement filed by U.S. Attorney Edward L. Stanton, III, and Assistant U.S. Attorney William W. Siler.

“The lawsuit, which was filed under seal in 2007, named multiple defendants, including two local physicians, Regional Hospital of Jackson, Jackson-Madison County General Hospital, and two former hospital administrators. While the United States has intervened in a portion of the case as it relates to an independent physician who serves on the medical staffs of both hospitals, the government declined to intervene in the case as it relates to all other defendants,” Regional Hospital spokesperson Lisa Ragsdale said in a statement.

“Regional Hospital of Jackson is pleased that the U.S. chose not to intervene in the portion of the relator's lawsuit which named the hospital and a former administrator. The hospital remains committed to providing high-quality, appropriate health services for patients and the community,” Ragsdale added.