An Elizabethtown cancer clinic accused of extending patients’ chemotherapy sessions so it could make more money has agreed to pay a $3.7 million settlement to resolve the claims against it.
Elizabethtown Hematology Oncology PLC and its owners were accused of extending the length of chemotherapy infusion treatments and improperly billing for office visits for those treatments so they could obtain larger reimbursements from government insurance programs, including Medicare, Medicaid and the military’s TRICARE program.
The owners, Dr. Rafik Ur Raman and Dr. Yusef K. Deshmukh, are also under investigation by the Kentucky Medical Board.
The settlement highlights how easily unsuspecting patients can be subjected to unnecessary procedures by doctors who want to collect more money.
Former Co-Worker Exposed Treatment and Billing Practices
The clinic’s billing practices came to light in a whistleblower lawsuit filed by a former doctor at the clinic, Dr. Ijaz Mahmood.
Mahmood claimed that the clinic gave patients the proper dose of chemotherapy, but diluted it so it took hours longer to administer. This allowed the clinic to make more money from government insurers such as Medicare, whose reimbursement is based partially on the amount of time a procedure takes. The lawsuit alleged that:
- The clinic had written guidelines that extended the duration of chemotherapy to three times beyond what was medically accepted as necessary, but sometimes stretched the duration to six to eight times longer than was needed.
- Patients sometimes spent hours hooked up to a chemotherapy IV when they could have received their doses with a simple injection.
The clinic’s attorney defended the actions of the clinic and its owners, saying that they were trying to minimize the drug’s harmful effects, not collect more money from insurers. He noted that the doctors are still practicing medicine and billing the government programs.
The settlement did not involve any admission of guilt on the clinic’s part, nor did the government concede that its claims were unfounded.
Settlement Terms Include Increased Monitoring
The federal and state government joined the lawsuit under the federal whistleblower law. Mahmood will receive $243,412 of the settlement amount, and the state of Kentucky will receive $405,227.
In addition to the monetary settlement, the clinic and Dr. Deshmukh must participate in a three-year program for increased monitoring and accountability of the clinic’s practices. The clinic and doctors will still be allowed to bill procedures to the government insurance plans.