Jury finds Ashland cardiologist guilty of performing unnecessary heart procedures
A federal jury has found a cardiologist from Ashland, Kentucky guilty of charges that he fraudulently billed Medicare, Medicaid, and private insurers for invasive heart procedures that were medically unnecessary.
LOUISVILLE, Ky. (WDRB) -- A federal jury has convicted a Kentucky doctor accused of performing unnecessary heart procedures on dozens of patients.
The U.S. Attorney's Office said in a statement that jurors returned a guilty verdict Thursday against Dr. Richard E. Paulus on charges of health care fraud and making false statements relating to health care matters.
Evidence presented at the 7-week trial indicates that, from 2008 to 2013, Paulus performed numerous invasive heart procedures on patients who did not need them. Paulus falsified medical records to exaggerate their medical condition and to make it appear that the heart procedures were necessary and qualified for payment.
Specifically, Paulus was convicted of placing unnecessary coronary stents and performing unnecessary diagnostic catheterizations in patients. He placed stents in more than 70 patients whose blockages were significantly less than 70 percent. Medicare, Medicaid, and private insurers will only reimburse for medically necessary procedures. Under medical standards of care, government and private insurers generally reimburse medical providers who place coronary stents in patients whose arteries are at least 70 percent blocked plus symptoms.
From 2006 to 2012, Paulus billed Medicare for more heart procedures than any other cardiologist in Kentucky and was number 5 in the nation in terms of amount paid by Medicare for stent procedures.
These medically unnecessary procedures were performed during his tenure at King’s Daughters Medical Center in Ashland.
In May of 2014, King’s Daughters Medical Center agreed to pay the U.S. Government $40.9 million to resolve civil allegations that it made millions of dollars by falsely billing federal health care programs for performing medically unnecessary heart procedures on patients.
Ten cardiologists testified on behalf of the United States.
Paulus faces 25 years in prison. He's set to be sentenced on April 25.
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