Office of the Attorney General
Owners of Elizabethtown Hematology Oncology, PLC Agree to Pay $3.7 Million to Settle False Billings to Health Care Programs
Attorney General Jack Conway, along with David J. Hale, U.S.
Attorney for the Western District of Kentucky, and the Office of Inspector
General for the U.S. Dept.
of Health and Human Services (OIG), announced Tuesday that Elizabethtown
Hematology and Oncology, PLC (EHO) and its owners have agreed to pay more than $3.7
million to resolve allegations that they extended chemotherapy treatment times
for their patients to maximize reimbursements and inappropriately billed office
visits for infusion therapies.
This case was investigated by Attorney General Conway’s
Medicaid Fraud and Abuse Control Unit and the OIG. It was prosecuted by the U.S. Attorney’s Office for the
Western District of Kentucky.
"We take very seriously our obligation to hold
accountable those who put profits ahead of patient care," Attorney General
Conway said. "I remain committed to
recovering taxpayer money that is lost to health care fraud in Kentucky. I appreciate the efforts of my Medicaid fraud
investigators who work every day to ensure that health care providers
participating in this type of deceptive behavior are held accountable, and I am
proud that our Medicaid Fraud Unit has been recognized as one of the most
aggressive in the country."
According to the settlement agreement, from Jan. 2005
through Dec. 2010, the United States and Commonwealth of Kentucky allege that the
owners of EHO, Dr. Rafiq Ur Rahman and Dr. Yusuf K. Deshmukh, billed Medicaid, Medicare,
TRICARE, and the Federal Employee Health Benefit Program (FEHBP) for
unnecessary office visit evaluations at the same time patients were receiving
chemotherapy or other types of infusion treatments. The United States and Commonwealth of
Kentucky contend that EHO did this by improperly billing evaluation and
"Manipulating treatment protocols and lengthening
infusion times to increase reimbursement reflect an extraordinary lack of
regard for patient welfare and the integrity of our health care system,” said
David J. Hale, U.S. Attorney for the Western District of Kentucky. “This settlement will end these unacceptable
practices and restore funds paid for improper claims during the relevant time
period. Pursuing health care fraud is a
priority of my Office and the Dept. of Justice.
We will continue to work with the Dept. of Health and Human Services to
pursue medical providers who engage in improper conduct and overbill government
health care programs."
"Improper and unnecessary services cost the taxpayers
millions of dollars each year and drains our nation’s health care system,"
said Derrick L. Jackson, Special Agent in Charge of the OIG’s regional office in
Atlanta. "The OIG will continue to aggressively pursue false claims cases
that return much needed dollars to government health care programs."
Some of the allegations covered by the settlement were
raised in a lawsuit filed against EHO and its owners under the whistleblower provisions
of the federal False Claims Act. In part
of his lawsuit, Dr. Ijaz Mahmood alleged that EHO developed written protocols
that increased chemotherapy infusion times by a factor of three or more beyond
generally recognized standards of medical practice. Dr. Mahmood alleged that EHO prolonged these
chemotherapy infusion times for longer than was medically necessary in order to
In addition to the $3.7 million payment, EHO and Dr.
Deshmukh entered into a three-year Corporate Integrity Agreement with the
OIG. The agreement requires enhanced
accountability and wide-ranging monitoring activities conducted by both
internal and independent external reviewers.