One of the top Medicare billers in the country, Central Florida cardiologist Asad Qamar, is the target of two lawsuits accusing him of systematic Medicare fraud, including padding bills and performing unnecessary procedures.
The U.S. Department of Justice’s civil division has joined in the whistleblowers’ cases on behalf of Medicare and Medicaid taxpayers. The lawsuits, filed in 2011 and 2014, were kept secret while the DOJ investigated and debated whether to join them.
DOJ tends to limit participation to cases in which it thinks it can win a substantial recovery. They were unsealed last week by federal judges in Tampa and Ocala.
One of the whistleblowers is a medical billing consultant, Holly Taylor of Sarasota. The other plaintiff so far has been called only “John Doe.” Under the False Claims Act, the initiators of the lawsuits stand to gain part of the money if a case ends in a settlement or a win at trial.
A call from Health News Florida to Qamar’s practice, the Institute of Cardiovascular Excellence, brought an e-mail response from attorney Greg Kehoe of the law firm Greenberg Traurig. He called the allegations “unsubstantiated” and “baseless,” and promised a vigorous defense.
“Dr. Qamar practices under the highest medical and ethical standards,” Kehoe wrote.
The John Doe complaint accuses Qamar of routinely performing unnecessary tests that brought a high Medicare payment. They include ultrasounds of blood flow in the legs, stress tests and Holter monitoring for the heart, and nuclear imaging. Records would be falsified to include symptoms that would justify the tests, his complaint says.
In a scarier allegation, Doe’s complaint says Qamar performed unnecessary catheterizations of the heart, a procedure that can have life-threatening complications. Cardiac catheterization involves inserting a flexible tube into a blood vessel and snaking it to the heart, injecting radioactive dye and taking nuclear images to show whether the blood is flowing properly in the coronary arteries and within the heart itself. Some patients were also subjected to unnecessary catheterization of blood vessels in arms and legs, the complaint says.
The complaint filed by Holly Taylor focuses more on billing. The consulting company that employed her assigned her as the account manager for Dr. Qamar and the Institute, reviewing their Medicare billings. She alleges that from 2008 to 2011, the US and the state of Florida were defrauded of “tens of millions of dollars.”
Taylor’s complaint says Qamar and the Institute regularly billed for procedures that were not performed at all through “upcoding,” instructing billers to code for more expensive procedures than the ones actually done. Also the physician routinely waived the 20 percent co-payment that Medicare requires patients to pay, Taylor said, probably to keep them from questioning why they were getting so many tests.
Her suit alleges that Qamar sometimes went ahead with catheterizations without first taking a history, examining the patient or checking labs. One patient died,Taylor’s complaint says, because she needed referral to a heart surgeon but Qamar delayed it to put stents in her leg vessels.
If there was any wrongdoing at the Institute, as the suits allege, the Florida Department of Health has not found it. Both of the Qamars have clear disciplinary records with no pending state complaints, according to the DOH web site.
Qamar and the Institute are named as defendants in both lawsuits. One also lists his wife, Dr. Humera Qamar.
The Institute, which was launched in 2009, is based in Ocala and boasts two cardiac catheterization labs. The practice has grown swiftly, with offices in Williston and two in The Villages.
According to the practice’s website, Qamar has recently launched two affiliates, the Institute of Medical Excellence in The Villages and Williston and the Limbstitute Center for Limb Salvage in Tavares.
In a New York Times article in April, Dr. Qamar said his organization has 150 employees and 23,000 patients. The article reported that in a study of U.S. physicians’ Medicare billings in 2012, Qamar was second in the nation, receiving $18.2 million. Medicare paid him four times as much as any other cardiologist.
–Carol Gentry, Health News Florida