Wednesday, November 2, 2016

Noted heart surgeon found guilty of health care fraud; exaggerated patient conditions to get Medicare payments

UPDATE, April 5: Judge Bunning overturned the conviction and the government has appealed his ruling, Mike James reports for The Independent.

Dr. Richard Paulus
(Ashland Independent photo)
In the latest judgment of health-care fraud in Kentucky, a well-respected cardiologist in Ashland was found guilty last week of performing unnecessary heart procedures on patients. From 2006 to 2012, Dr. Richard E. Paulus at King's Daughters Medical Center billed Medicare "for more heart procedures than any other cardiologist in Kentucky and was fifth in the nation in the amount paid by Medicare for stent procedures," Andrew Wolfson reports for The Courier-Journal.

"Attorneys for Paulus have asked U.S. District Judge David L. Bunning to acquit Paulus, arguing that, at most, the evidence showed only honest mistakes or disagreements among cardiologists," Rachel Adkins reports for The Independent of Ashland. If Bunning refuses, Paulus lawyer Robert Bennett of Washington, D.C., said they will appeal.

A Covington jury convicted Paulus "after a seven-week trial and four days of deliberations . . . of performing numerous invasive heart procedures on patients who did not need them from 2008 to 2013, and to justify the procedures, falsifying their medical records to exaggerate their medical condition so he could qualify for government payments," Wolfson writes. "Ten cardiologists testified on behalf of the United States, and Paulus was convicted on 11 counts and acquitted on five counts."

Paulus, for whom the hospital's vascular center is named, is the third Kentucky cardiologist to be convicted of health-care fraud. Published reports say he earned $2.6 million in 2011 alone. He was specifically convicted for placing unnecessary coronary stents and performing unnecessary diagnostic catheterizations in patients, Wolfson writes, noting that stents "can save lives of heart-attack victims, but their use in stable patients has been disputed by medical researchers."

Hospital vascular center named for Paulus (Independent photo)
Paulus retired last summer. The hospital said in a statement: "Since the beginning, King’s Daughters has stood behind our cardiac program. Our heart program has continued to meet or exceed national performance standards. Independent experts have been reviewing our cases and agree that the heart care we provide is excellent."

In 2014 King's Daughters agreed to pay the federal government $40.9 million to settle civil allegations that it made millions of dollars by falsely billing federal health programs for performing heart procedures on patients who did not need them, Wolfson notes. He also recounts other recent health-care fraud cases.

Paulus faces a maximum of 20 years for health care fraud and up to five years for making false statements. His sentencing is scheduled for April 25. About 100 people attended a Sunday prayer service for Paulus, Adkins reports.

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