Jackson doctor accused of Medicaid fraud-- $4.15M settlement reached in case

By Douglas Levy

Dolan Media Newswires

A Jackson-based cardiology practice and a hospital system have settled a False Claims Act case with the U.S. government and the state of Michigan for $4,150,988.

The suit, filed under the qui tam provisions of the Act, asserted that the defendant cardiologist inaccurately recorded patients' stress tests results as "abnormal," then billed Medicare and Medicaid for the unnecessary cardiac procedures that followed.

Birmingham attorney Monica P. Navarro represented Dr. Julie A. Kovich, who will receive part of the settlement because, as the "relator," had knowledge of fraud and filed the lawsuit on the government's behalf.

Navarro noted that what made this case unique is the fact that Kovich is a cardiologist herself and was willing to expose the fraudulent conduct.

"These are the kinds of cases [where] it's difficult to detect conduct, because they involve specialized medical knowledge," said Navarro of Vezina Law PLC. "Unless you have someone with equal training who's willing to put their neck on the line, to expose what is happening, these cases go undetected for years and years, and people get hurt as a result. ... It's as bad a white-collar crime gets."

Kovich, who had previously been employed as an independent contractor at defendant Jackson Cardiology Associates, alleged that Dr. Jashu R. Patel and other Jackson Cardiology Associates physicians performed unnecessary cardiac procedures -- many of which happened at defendant Allegiance Health's W.A. Foote Memorial Hospital in Jackson -- that were billed and paid for by Medicare or Medicaid.

The claim further stated that, when Allegiance officials received multiple complaints and warnings from Kovich that Patel was performing these unnecessary procedures, the health system continued to allow him to do so.

Navarro, who tried the case with co-counsel J. Marc Vezina, noted that in dealing with potential relators, qui tam lawyers really do become counselors.

"[Relators] come to you and they're very concerned about the patients," she said, "but they're also concerned about themselves, because they know that the potential repercussions to them are very significant.

"Ultimately you're empowering the relator with how they're going to pursue the case by informing them, with the pros and the cons. Because it's their call."

It can be a very "isolating" experience, Navarro noted, as the case remains under seal until a judgment, settlement or dismissal, and information during that time can't be shared with anyone, even close family.

And even though a relator can receive an award from the settlement or judgment, the biggest risk is the relator's name becoming public once the case is concluded.

This can lead to the relator being ostracized from others in her field, which, Navarro said, has been happening to Kovich.

To that end, Kovich has been advised to be vigilant.

"[O]bviously, we want make sure she's protected," Navarro said. "She did the right thing by exposing really bad conduct, and it's remarkable that some people think it was wrong of her to expose it. Some adhere to a culture of silence. It's very disappointing."

The U.S. Attorney's Office in Detroit, which investigated and intervened in the case, interviewed witnesses, including other cardiologists at the practice and hospital staff. But Navarro said their testimony did not factor in as much as the written evidence.

"The patient charge really made the case itself. There were some very clear standards of care that were not observed and once those patients were identified and the medical records were reviewed, it was really a case of documentation," she said.

"You didn't necessarily need anecdotal evidence, because it boiled down to, were these tests and invasive procedures medically necessary, based on objective medical standards. And they were not."

Allegiance Health agreed to pay $1,824,928 to the federal government and $126,060 to the state of Michigan. Jackson Cardiology Associates and Patel agreed to pay $2.2 million to the federal government.

Kovich will receive approximately $764,700 as the relator.

Gregory G. Drutchas of Detroit-based Kitch Drutchas Wagner Valitutti & Sherbrook, who represented Alliance, could not be reached for comment.

In a statement, Alliance said it "disagrees with the allegations made by the government and admits no wrongdoing," but "reached an agreement in order to devote resources to providing excellent healthcare for the community rather than litigation."

Andrew B. Wachler of Wachler & Associates PC in Royal Oak, represented Dr. Jashu R. Patel and other Jackson Cardiology Associates; he could not comment on the matter.

The False Claims Act "takes very seriously systematic, intentional and knowing conduct," Navarro said. "It's a very high threshold of that intent that you have to demonstrate in order for the False Claims Act to make the conduct actionable."

Published: Mon, Aug 12, 2013

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