A Florida doctor has recently agreed to pay a $1.95 million settlement to resolve numerous allegations of Medicare billing fraud. According to the Medicare billing fraud allegations, the cardiologist billed the federal healthcare program for unnecessary ultrasound tests and other medical exams.

Dr. Arthur S. Portnow and his practice, which operates as Apple Medical Group, allegedly billed hundreds and thousands of dollars to Medicare for medically unnecessary exams and tests between August 2009 to August 2017. According to the qui tam lawsuit, Dr. Portnow and his practice conducted this Medicare billing fraud scam to maximize profits.

This qui tam lawsuit was filed by whistleblower Kathleen S., who reported the alleged Medicare billing fraud to the federal government. Kathleen worked for Dr. Portnow as a certified technologist, and had allegedly witnessed unusual billing practices almost as soon as she started her employment. Among the odd billing practices she noticed, Kathleen says she was asked to provide falsified patient records for the Medicare billing statements.

Medicare billing fraud, or billing fraud to healthcare programs in general, is one of the most prevalent fraud concerns in the United States. This occurs when a doctor or medical institution bills Medicare, Medicaid, or other federal healthcare programs fraudulently to get reimbursements they’re not entitled to.

The medical procedures billed for are often unnecessary, or they may never have been received by patients. Once doctors bill Medicare, they collect the money for themselves.

Medicare billing fraud is a serious problem in the United States, as it deprives recipients of much needed medical services and impacts the country’s taxpayers.

Overview of Medicare Billing Fraud Allegations

According to Kathleen’s whistleblower lawsuit, there were a number of Medicare bill fraud actions going on in Dr. Portnoy’s office. The practice allegedly billed for unnecessary lower extremity atrial ultrasounds, abdominal aortic ultrasounds, renal and renal artery ultrasounds, and echocardiograms.

Dr. Portnow also wanted reimbursement for his own service, and he allegedly expected Kathleen and other employees to falsify medical records of patients to justify the medical procedures and billing statements.

Kathleen filed the qui tam lawsuit under seal in April 2015. It was unsealed on March 2, 2017 after undergoing extensive review by the federal government. Along with the federal government, the state of Florida is also taking part in the qui tam lawsuit.

Federal prosecutors continued to investigate the whistleblower claim until Sept. 27, 2017, when the settlement proposal was submitted. According to the qui tam settlement agreement, Dr. Portnow will not only pay the settlement but will also sign an integrity agreement with the inspector general of the United States Department of Health and Human Services.

For her role as a whistleblower, Kathleen will receive approximately $350,000 of the settlement. Under the False Claims Act, whistleblowers typically receive between 15% to 30% of any settlement awarded, since their efforts are considered very important preventative tools against fraud.

“Fraudulently billing the government for medically unnecessary tests deprives federal health care programs, like Medicare, of valuable resources,” one of the acting attorneys stated.

The Medicare Billing Fraud Lawsuit is Case No. 8:15-cv-00987, in the U.S. District Court for the Middle District of Florida.