West Chester Hospital in Cincinnati, and its parent company UC Health, have agreed to pay $4.1 million in a False Claims Act settlement relating to claims they billed Medicare and Medicaid for medically unnecessary spine surgeries performed by Dr. Abubakar Atiq Durrani of Mason, Ohio. The original civil suit was filed by several of Dr. Durrani’s former patients under the qui tam provision of the False Claims Act.
Health Care Fraud: Unnecessary Spine Surgeries, Bills to Medicare
Abubakar Atiq Durrani is now considered a fugitive from the law and this settlement between the U.S. government and West Chester Hospital does not absolve Durrani of the criminal charges against him. According to the allegations in the lawsuit, Durrani performed millions of dollars’ worth of medically unnecessary spine surgeries between 2009 and 2013, which he then billed to federally funded health programs. Durrani was arrested and charged in July 2013 in connection with the allegedly unnecessary surgeries.
Durrani was then officially indicted by a federal grand jury in Cincinnati on ten counts of health care fraud for allegedly persuading patients to have unnecessary and potentially damaging medical procedures. According to the allegations made during his criminal trial, Durrani convinced patients that without spine surgeries they would experience serious consequences, including paralysis. After his arraignment, Durrani requested to visit his ailing father in his native Pakistan, but the request was denied. Shortly thereafter, Durani allegedly fled the United States and remains a fugitive.
Durani’s Victim Patients were Whistleblowers - $800K Qui Tam Award
The agreement between the Department of Justice and West Chester Hospital settles the healthcare fraud charges against the hospital, and requires the hospital to repay $4.1 million. Of that $4.1 million, the former patients of Durani who brought forth the original suit will receive approximately $800,000 as their reward for whistleblowing. The states of Kentucky and Ohio will receive approximately $72,000 as repayment since their state Medicaid programs paid for some of the procedures in question. The remaining amount of the settlement will pay back the federal government for the allegedly fraudulent claims that were paid out.
Regarding the settlement, Principal Deputy Assistant General Benjamin C. Mizer, head of the Justice Department’s Civil Division, said “Hospitals have a responsibility to ensure that services at their facilities are medically necessary and appropriate before they bill federal health care programs for those services. When providers charge for medically unnecessary services, we will aggressively seek remedies under the False Claims Act.”
“Federal health care programs cover only those procedures that are medically necessary,” said U.S. Attorney Carter M. Stewart of the Southern District of Ohio. “The U.S. Attorney’s Office is committed to pursuing providers that seek payment for unnecessary medical procedures.”
HHS-OIG Official Says Greed to Boost Profits Put Patients in Peril
“Any time greed replaces medical necessity as the primary factor in performing invasive procedures and surgeries on Medicare and Medicaid patients, our most vulnerable citizens – the elderly, disabled, and economically disadvantaged – are imperiled,” said Special Agent in Charge Lamont Pugh of the Health and Human Services Office of Inspector General (HHS-OIG). “Medical businesses and physicians who unnecessarily place patients at risk to boost profits will be held accountable for their actions.”
This settlement is another success in the government’s ongoing, comprehensive fight against healthcare fraud. Since 2009, the Department of Justice has recovered more than $25 billion in False Claims Act cases, with a significant percentage of those cases involving healthcare fraud.