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Cardiologist is investigated for charging Medicare $18m in one year

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h765 (Published 10 February 2015) Cite this as: BMJ 2015;350:h765
  1. Owen Dyer
  1. 1Montreal

The US Department of Justice has joined two whistleblower lawsuits against the country’s top billing cardiologist, Asad Qamar of Ocala, Florida, for charging Medicare for unnecessary interventions for peripheral vascular disease.

The suits, filed under the False Claims Act, accuse the doctor, and his Institute for Cardiovascular Excellence, of intervening in almost every patient who is scanned for peripheral vascular disease.

It would be “statistically impossible to medically support the number of interventions for which Dr Qamar and ICE billed for in 2010-11,” one lawsuit contends. Of $18m (£12m; €16m) in Medicare payments that Qamar received in 2012—the second highest amount paid to any physician in the country—$13m was for procedures to treat vessels outside the heart, mostly in the legs. One patient had an unnecessary stent inserted in her leg when she needed coronary revascularization, the suit alleges. She died of complications from that stent while awaiting stenting of the other leg.

An analysis of Medicare billing data by the Advisory Board Company, an analysis and research firm, showed that while the number of percutaneous coronary interventions fell by 30% nationally from 2005 to 2013, to about 323 000 a year, interventions to unblock vessels outside the heart rose by almost 70% to 853 000 a year.

Citing that study in the New York Times, reporters Julie Cresswell and Reed Abelson wrote, “At a time of increasing scrutiny of procedures to open blocked heart arteries, cardiologists are turning to—and reaping huge payments from—controversial techniques that relieve blockages in the arms and legs.”1

The newspaper’s own analysis found that of the country’s 10 top billing cardiologists, eight were making about half of their reimbursements through treatment of blockages in the extremities.

But the New York Times article drew a sharp response from Joshua Beckman, former president of the Society for Vascular Medicine, who told The BMJ that his organization’s views had been misrepresented. “The article claimed that the Society warns that people typically do not need invasive treatment. What we actually said, in submitting our list of potentially overused treatments to the Choosing Wisely campaign, was that intervention is unjustified in asymptomatic cases.

“Also, the New York Times focuses on peripheral artery interventions. But their own data shows these have been fairly stable since 2005. It’s vein interventions that have exploded.

“As these other [coronary] interventions have been going down, people have been looking for things to do, that’s part of it. Also, this area is not covered by any particular specialty. There’s a group of people calling themselves experts in venous and lymphatic disease, and there’s an interest in this becoming someone’s niche,” Beckman said. Most practitioners tried to follow the evidence, he said. “But there’s always a bell curve distribution with any treatment. I’m sure some are overtreating, while in other cases patients are suffering from undertreatment.”

A supervised regime of diet and exercise was as effective in peripheral artery disease as revascularization, said Beckman, but “it has to be supervised to be effective, and Medicare, while it reimburses intervention, does not reimburse supervision of exercise in PAD [peripheral artery disease]. That’s a conversation we should be having.”

In a video he posted on You Tube, Qamar rebutted the government’s allegations, arguing that his service had prevented many amputations.2

Notes

Cite this as: BMJ 2015;350:h765

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