— Dinesh Shah, MD, allegedly billed for tests that were unnecessary or never done
by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today March 23, 2021
Cardiologist Dinesh Shah, MD, has paid the U.S. government $2 million to settle charges that he billed federal healthcare programs for diagnostic tests that weren’t necessary or were never performed, according to the Department of Justice.
Prosecutors alleged that from 2006 to 2017, Shah and his practice Michigan Physicians Group billed Medicare, Medicaid, and Tricare for unnecessary testing, typically involving the ankle-brachial index and the toe-brachial index — both a measure of how well blood is flowing from the heart to the extremities.
These tests were routinely performed on patients without first being ordered by a physician and without regard to whether they were medically necessary, according to DOJ. The agency also focused on unnecessary nuclear stress tests — which involve radioactive contrast injections — performed at the clinic.
“Subjecting patients to unnecessary testing in order to fill one’s pockets with taxpayer funds will not be tolerated,” said Acting U.S. Attorney Saima Mohsin in a statement. “Such practices are particularly concerning because overuse of some tests can be harmful to patients.”
The settlement is connected to one from 2018, in which William Beaumont Hospital in Royal Oak, Michigan, paid $84.5 million to resolve allegations that it had improper relationships with eight referring physicians.
Those relationships led to the submission of false claims to Medicare, Medicaid, and Tricare from 2004 to 2012, prosecutors said at the time.
Shah was one of the eight physicians named in DOJ’s 2018 case, but he — along with the two other private practice cardiologists named in the settlement — denied involvement at the time.
Prosecutors said that Beaumont doled out compensation to those doctors that was way above fair market value in order to secure their referrals of patients to the system. The hospital also allegedly provided free or cheap office space, as well as employees like nurses to work for those doctors.
The schemes came to light with the filing of four whistleblower lawsuits — but neither Shah nor the other two private practice cardiologists were named in those suits, according to a 2018 story in Crain’s Detroit Business. More than 21 physicians in total were named in those four lawsuits.
DOJ said Shah’s recent case originated in two other whistleblower lawsuits, filed separately by two former employees of Michigan Physicians Group: Arlene Klinke and Khrystyna Mala.
In addition to the fine, Shah and his practice also entered into an Integrity Agreement with HHS Office of Inspector General, which will provide some oversight of the company’s billing practices for a 3-year period.
The DOJ’s press release noted that there’s been “no determination of liability” in Shah’s case. Similarly, Beaumont was able to deny any wrongdoing in resolving its 2018 case.
Beaumont has been embroiled in drama in which its physicians have been vocal about their lack of confidence in corporate leadership. Their complaints have focused on a “toxic culture” and administrators’ pursuit of profits over patients.
The 8-hospital health system was set to merge with Advocate Aurora Health last fall, but the deal fell through after physicians, lawmakers, and other stakeholders fiercely opposed the merger.