Hazard, Ky.-based Appalachian Regional Healthcare and one of its cardiologists agreed to pay over $3 million to resolve allegations they submitted improper Medicare and Kentucky Medicaid claims for services not covered.
Padubidri Chandrashekar, MD, allegedly had ARH bill Medicare and Kentucky Medicaid for diagnostic catheterization procedures that took place at ARH Hazard but lacked sufficient documentation to back up the medical need, according to a Nov. 28 Justice Department news release.
Prior to the procedures, Dr. Chandrashekar and his Mountain Heart Center practice allegedly billed for medically unnecessary patient appointments for diagnostic catheterizations and admitted patients in advance to ARH Whitesburg. Additionally, the allegations claim that Dr. Chandrashekar caused improper billing of ambulance transfers for said patients to be taken from ARH Whitesburg to ARH Hazard for their procedures.
The Justice Department also alleged ARH submitted Medicare and Medicaid false claims for the patient admissions, as they did not meet their severity of illness or intensity of services requirements.
AHR agreed to pay over $2.8 million in the settlement agreement to resolve its civil liability for improper billings and federal False Claims Act liability. Dr. Chandrashekar and Mountain Heart Center agreed to pay almost $150,000 in a separate settlement agreement to resolve their False Claims Act liability.