A whistle-blower lawsuit filed in the U.S. District Court for Western Pennsylvania accuses 5 cardiologists of defrauding Medicare by performing unnecessary cardiac procedures.
The qui tam suit, filed by Dr. Tullio Emanuele, alleges that Drs. Richard Petrella, Robert Ferraro, Charles Furr, Timothy Trageser and Donald Zone "made or caused to be made false claims and statements to Medicare to obtain reimbursement for cardiac and vascular surgical and diagnostic procedures that were not medically necessary, that were overbilled, or otherwise improperly billed," according to court documents.
Emanuele, who worked alongside the 5 defendants at a medical center in Erie, Pa., between 2001 and 2005, filed the suit on behalf of the U.S. government. If the feds decide to join the case, he stands to make a up to third of any recovery awarded by the court.
The suit also accuses Medicor Associates, its affiliate Flagship Cardiac, Vascular, and Thoracic Surgery and the University of Pittsburgh Medical Center – Hamot of complicity in a kickbacks scheme to drive referrals to the centers. It alleges that the centers inked deals worth between $75,000 and $525,000 a year with the cardiologists, who would refer patients to the Hamot clinic.
"Specifically, Hamot identified physicians who referred a high volume of patients and/or had potential to refer a high volume of patients for special treatment and offered remuneration to them in the guise of sham contracts for medical directorships or other similar personal service arrangements," according to the documents. "Beginning in 2004, [Emanuele] began to notice higher rates of intervention among certain physicians in the group. During the period from April 2004 through February 2005, the cath lab activity records show that 4,408 catheterizations were performed and that Drs. Petrella, Trageser and Ferraro had a rate of surgical intervention following catheterization of double the junior members of the group."
In one case, Trageser allegedly performed a cardiac catheterization on a patient with no symptoms, who later died after developing complications from the procedure, according to the lawsuit.
The suit seeks a jury trial, triple damages, civil penalties and legal fees for 4 counts under the False Claims Act.
A spokeswoman for UPMC Hamot told the Erie Times-News that the hospital does not comment on pending litigation and that Medicor, Flagship CVTS and the accused doctors would have no comment.