Cardiovascular Specialists, Inc., an Oklahoma-based corporation operating a cardiology clinic in Tulsa, and Dr. Stewart Katz have settled civil claims for $270,000. The settlement addresses allegations of submitting false claims to Medicare and TRICARE, as announced by U.S. Attorney Robert J. Troester.
The allegations concern improper "incident-to" billing practices from January 1, 2016, through February 28, 2020. It is claimed that Cardiovascular Specialists and Dr. Katz submitted or caused the submission of claims for evaluation and management services under Dr. Katz's National Provider Identification number when such services were performed by nurse practitioners without his supervision at the clinic.
Additionally, from January 1, 2015, through June 16, 2022, it is alleged that they submitted or caused the submission of claims to Medicare and TRICARE for services that should have been billed at a lower reimbursement level.
These allegations were initially raised in a lawsuit filed by a whistleblower who previously worked with Cardiovascular Specialists. The lawsuit was filed under the qui tam provisions of the False Claims Act in federal district court in Oklahoma City. This act allows private individuals to sue on behalf of the United States for false claims and share in any recovery.
As part of the settlement agreement, Cardiovascular Specialists and Dr. Katz did not admit liability while the United States made no concessions regarding the legitimacy of these claims. The settlement allows both parties to avoid further litigation costs and uncertainties.
The investigation received assistance from the Defense Criminal Investigative Service and HHS-OIG Office of Audit Services. Assistant U.S. Attorneys Ronald R. Gallegos and Amanda R. Johnson prosecuted this case.