Unnecessary procedures cost Kentucky cardiologist $1M, 5 years in prison

Unnecessary procedures cost Kentucky cardiologist $1M, 5 years in prison.  Medical procedures and orders must be backed by supporting chart documentation and appropriate ICD-10 coding.  All government and commercial payors use claims data to build and compare provider profiles. A  Compliance program which includes services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com would identify these type of overutilization and documentation issues.

Unnecessary procedures cost Kentucky cardiologist $1M, 5 years in prison

Source from: May 03, 2019 | Anicka Slachta | Healthcare Economics & Policy

A former Kentucky cardiologist received five years of prison time May 2 after allegedly performing numerous unnecessary heart procedures as part of a healthcare fraud scheme.

Richard Paulus, 71, was first implicated in the scheme in 2016, when we was found guilty of placing unnecessary coronary stents and performing unnecessary diagnostic catheterizations in his patients. At the time, he faced up to 25 years in jail for healthcare fraud and making false statements, but this month’s decision condensed that possibility to half a decade.

Federal authorities allege Paulus performed numerous unnecessary invasive heart procedures between 2008 and 2013, falsifying medical records to fraudulently bill Medicare, Medicaid and private insurance companies. The physician reportedly billed Medicare for more heart procedures than any other cardiologist in Kentucky between 2006 and 2012—a period during which only four other cardiologists in the country received higher Medicare payments for stent procedures.

According to the Daily Independent, a local Ashland, Ky., paper, Paulus maintained his innocence this week in front of U.S. District Judge David Bunning, who said he was imposing Paulus’ sentence out of respect for the jury’s guilty verdict.

“You’ve given up a lot already,” Bunning said, per the Independent. “You’ve suffered a lot already.”

Assistant U.S. Attorney Kate Smith was less lenient, noting Paulus was paid $2.5 million a year by his former hospital, King’s Daughters Medical Center, as part of a compensation plan that generated more money when more procedures were performed. In 2014, the hospital agreed to pay $40.9 million in a civil settlement.

Paulus has been ordered to pay around $1 million in restitution—approximately the same amount it cost to go through with all the unnecessary procedures. Bunning has allowed him to remain out of custody until he starts serving his sentence June 24, though defense attorney Bob Bennett said he was disappointed in the sentence and will appeal.

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