A cardiologist once part of William Beaumont Hospital's so-called "Royal Family" of doctors and his Oakland County practice have paid $2 million to settle false claims allegations related to excessive or unnecessary diagnostic testing over 12 years.
Dr. Dinesh Shah and the Michigan Physicians Group P.C. were alleged to have billed Medicare, Medicaid and the military Tricare program for improper diagnostic testing from 2006 to 2017, according to a statement Thursday evening from the U.S. State's Attorney's Office of the Eastern District of Michigan in Detroit.
MPG is a Michigan professional corporation with primary offices in Berkley and Livonia with administrative offices, labs, and testing sites at other locations around metro Detroit.
Shah is the sole owner of MPG. He did not respond Friday morning for a comment about the settlement. Others named in the state's attorney's statement were Dr. Alka Shah, Dr. Rita Shah and Tatiana Shcherbich.
"Subjecting patients to unnecessary testing in order to fill one's pockets with taxpayer funds will not be tolerated. Such practices are particularly concerning because overuse of some tests can be harmful to patients," Acting U.S. Attorney Saima Mohsin said in a statement. "With these lawsuits and the accompanying resolution, Dr. Shah and Michigan Physicians Group are being held to account for these exploitative and improper past practices."
Shah also was one of seven cardiologists, a general surgeon and at least four other doctors or executives named in four whistleblower lawsuits settled by Beaumont in 2018. They were alleged to be involved in a scheme at Beaumont Hospital in Royal Oak that led to the submission of false claims to the Medicare, Medicaid and the military Tricare programs from 2004 to 2012, according to court documents.
Called the "Royal Family" by other doctors, the physicians including Shah were alleged to have been given lucrative perks, paid in excess of $700,000 annually by Beaumont, given the use of hospital employees for their office practice without charge.
In 2018, Beaumont agreed to pay $84.5 million to settle a variety of state and federal physician kickback and false allegations. Under the settlement, Beaumont also entered into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services.
Dinesh, Alka and Rita Shah are listed as members of the Beaumont medical staff.
The alleged illegal practices occurred before the merger that created the current Southfield-based Beaumont Health, one of the largest health systems in Michigan with eight hospitals and more than 5,000 doctors and 38,000 employees.
The settlement with Shah comes after two whistleblowers, Arlene Klinke and Khrystyna Mala, who worked for MPG, filed "qui tam" lawsuits under provisions of the U.S. False Claims Act.
The act permits private parties to file suit on behalf of the U.S. government and to share in any recovery. It was unclear how much the whistleblowers were awarded out of the total fine, but Justice Department guidelines allows them to share between 15 percent and 25 percent of the settlement.
The whistleblowers alleged and the investigation focused on unnecessary nuclear stress tests and other diagnostic tests that included "ankle brachial index" and "toe brachial index" tests. The tests were routinely performed on patients without first being ordered by a physician and without regard to medical necessity, the U.S. attorney's statement said.
The ABI compares blood pressure in the ankle to blood pressure in the arm to determine how well blood is flowing from the heart to the feet. The TBI is an additional measure to assess blood pressure readings at the toes.
During a Nuclear Stress Test, a small amount of radioactive tracer is injected into a vein, after which it is detected by a special camera that produces images used to evaluate blood flow to the heart.
"Physicians commit to providing and billing for only medically necessary services when they choose their profession and participate in federally funded health care programs," said Lamont Pugh III, special agent in charge, USDHHS, Office of Inspector General – Chicago Region, in a statement.
"To deviate from that commitment and potentially place their patient's health and safety at risk as well as limited tax payer resources is unacceptable," Pugh said. "The OIG will continue to work with our federal, state and local partners to ensure that patients and tax payer dollars are protected."
Besides Assistant U.S. Attorneys Leslie Wizner and Lynn Dodge in Detroit, investigators included the Office of Inspector General for the USDHHS and the Defense Health Agency acting on behalf of the TRICARE Program.
The Michigan Attorney General's Office participated in the settlement as the State of Michigan was a named plaintiff in one of the cases, the court documents said.
Shah and MPG also entered into a three-year corporate integrity agreement with the Office of Inspector General for the USDHHS. The agreement provides for oversight of Shah and MPG's billing practices over the next three years and allows for additional penalties if any infractions are found.
During the next 60 days, MPG must post a notice of the agreement in a prominent place at the practice's offices. The notice includes the HHS OIG Fraud Hotline telephone number (1-800-HHS-TIPS) to report suspected fraud or abuse.
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