Cadiologist Sentenced to 78 Months for Fraud

Patients Given Treatments Deemed to be Unnecessary
   NEWARK, N.J. – 11/30/2013 - A well-known cardiologist and the founder, CEO and sole owner of two large medical services companies in New Jersey and New York was sentenced on Nov. 20 to 78 months in prison and ordered to pay $19 million in restitution for conspiring in a multimillion-dollar health care fraud scheme that subjected thousands of patients to unnecessary tests and potentially life-threatening, unneeded treatment, as well as treatment by unlicensed or untrained personnel.
   The sentence was announced by New Jersey U.S. Attorney Paul J. Fishman.
   Jose Katz, 69, of Closter, N.J., previously pleaded guilty before U.S. District Judge Jose L. Linares to an information charging him with one count of conspiracy to commit health care fraud and one count of Social Security fraud arising from a separate scheme to give his wife a “no show” job and make her eligible for Social Security benefits. Judge Linares imposed the sentence in Newark federal court.
   “Katz prized illegal profits over patients to a staggering degree, committing record-breaking fraud and compromising care,” Fishman said. “Prison is an appropriate consequence for ripping off the government and insurance companies through the shocking exposure of patients to unneeded or untrained treatment.”
   As part of his plea agreement with the government, Katz agreed that the loss amount sustained by Medicare, Medicaid and other insurers victimized by the fraudulent billings was $19 million. U.S. Department of Health and Human Services, Office of Inspector General and FBI records indicate the loss amount suffered by the victims is the largest recorded in New Jersey, New York and Connecticut for an individual practitioner convicted of health care fraud.
   According to documents filed in this case and statements made in court:
   Katz was the founder, CEO and sole equity-holder of Cardio-Med Services LLC (Cardio-Med), and Comprehensive Healthcare & Medical Services LLC (Comprehensive Healthcare). From 2004 through 2012, Cardio-Med had offices in Union City, Paterson and West New York, N.J., and Comprehensive Healthcare had offices in Manhattan and Queens, N.Y. Both Cardio-Med and Comprehensive Healthcare provided cardiology, internal medicine and other medical services to individual patients. During that time period, Katz conspired to bill Medicare Part B, Medicaid, Empire BCBS, Aetna and others for unnecessary tests and unnecessary procedures based on false diagnoses and for medical services rendered by unlicensed practitioners.
   Between July 2006 and February, 2009, Katz spent more than $6 million for advertising on Spanish-language television and radio stations. The ads attracted hundreds of patients to Cardio-Med and Comprehensive Healthcare every day. Overall, Katz was able to bill Medicare and Medicaid more than $75 million for his services from 2005 through 2012.
   Over the course of the conspiracy, Katz ordered and performed essentially the same battery of diagnostic tests for nearly all the patients he treated, regardless of their symptoms. Katz also instructed his non-physician employees to order and perform diagnostic tests for patients of other doctors working at his offices, even though he had not examined those patients and the other physicians had not ordered the tests.
   Most significantly, Katz admitted that he falsified patient charts with fictitious and boilerplate symptoms and falsely diagnosed a majority of his Medicare and Medicaid patients with coronary artery disease and debilitating and inoperable angina. He also admitted to making the diagnoses to justify prescribing and administering an unnecessary treatment for those patients called enhanced external counter pulsation, or EECP. Katz even prescribed EECP treatments for some patients with contraindications for the treatment, therefore subjecting those patients to a substantial risk of serious injury or death.
   From 2005 through 2012, Medicare and Medicaid paid Katz more than $15.6 million just for his EECP treatments, most of which were fraudulent.
   In addition, Katz ordered conspirator Mario Roncal, 62, of Woodland Park, N.J. – who had a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico, but did not have a license to practice medicine in any of the 50 states – to treat patients, knowing he was not licensed. At Katz’s direction, Roncal held himself out to fellow employees and to patients as “Dr. Roncal,” examined new patients as well as Katz’s follow-up patients, ordered diagnostic tests, diagnosed patients with medical conditions and diseases and recommended and prescribed courses of treatment and surgery – including falsely diagnosing patients with angina and prescribing EECP treatments for those patients.
   To conceal this illegal and unlicensed practice of medicine, Roncal forged Katz’s signature on paperwork associated with Roncal’s unlawful medical services, including on patient charts. During the conspiracy, Katz used his own billing numbers to bill Medicare Part B and Medicaid for the illegal services Roncal provided as though they were provided by Katz.
   Roncal was indicted on March 2, 2012, for conspiracy to commit health care fraud. He entered a guilty plea on Jan. 4 and awaits sentencing.
   Katz also admitted to a Social Security fraud scheme in which, from 2005 through 2012, he kept his wife on Cardio-Med’s payroll though she performed little or no work. During the course of the scheme, Katz sent false W-2 forms for calendar years 2005 through 2011 to the U.S. Social Security Administration purportedly reflecting $1,251,604 in earnings for his wife, making her eligible for an estimated $263,000 in Social Security benefits to which she was not entitled.
    In addition to the prison term and restitution, Judge Linares sentenced Katz to serve three years of supervised release.
   U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford; the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Thomas O’Donnell; the U.S. Postal Inspection Service, under the direction of Inspector in Charge Maria Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Special Agent in Charge Shantelle P. Kitchen; and criminal and civil investigators with the U.S. Attorney’s Office for the investigation leading to today’s sentence. He also thanked the Medicaid Fraud Division of the Office of the New Jersey State Comptroller for its assistance.
   The government is represented by Assistant U.S. Attorney Scott B. McBride of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
   Source: U.S. Department of Health and Human Services; U.S. Department of Justice

EWG Questions White House, EPA Over Decision

   WASHINGTON, D.C. – 11/26/2013 - The Environmental Working Group has submitted Freedom of Information Act requests to the White House to learn whether industry improperly influenced the government’s decision to drop two proposals to strengthen public health protections from toxic chemicals. The Environmental Protection Agency withdrew the proposals in September after they had been bottled up at the White House Office of Management and Budget for more than a year.
   “Once again red tape appears to have choked EPA efforts to enhance environmental and human health protections, forcing EPA to go back to the drawing board,” EWG’s General Counsel Thomas Cluderay said.
   Under the leadership of former EPA Administrator Lisa P. Jackson, the agency had launched two initiatives to protect the public from toxic chemical exposures, relying on its limited authority under the weak federal law known as the Toxic Substances Control Act. In 2010, EPA proposed a regulation to establish a short list of chemicals thought to pose a risk to public health. Then in 2011, the agency set out to require chemical companies to disclose more information about their products.
   As required by law, EPA submitted the proposals to OMB’s Office of Information and Regulatory Affairs, the White House’s powerful gatekeeper that oversees rulemaking by federal agencies. The proposed rules never cleared OMB, and on Sept. 6, EPA surprised the public interest groups by abandoning the effort. Officials said the rules had been made unnecessary by other steps EPA had taken and that requiring companies reveal the identity of chemicals in health and safety studies submitted to the agency would cause industry to stop providing its studies.
   The public had no opportunity to weigh in on either initiative because they were never published for public comment, but White House records show that OMB met with a host of special interests to discuss the rules, particularly representatives of the chemical industry.
   “The public deserves to know what hand the chemical industry had in pressuring OMB to hold up, and EPA to fold on, these efforts to protect public health,” Cluderay said. “EWG will use the requested records to answer that very question.”
   EPA’s backpedaling is particularly relevant to the ongoing debate over reforming the Toxic Substances Control Act. The chemical industry is backing the proposed Chemical Safety Improvement Act of 2013, a deeply flawed bill that, among other defects, would expand companies’ ability to keep information about chemicals confidential.
   Source: Environmental Working Group

COPD Study: Patient-Provider Dialogue Lacking

   (NIH) - 11/23/2013 - Lack of communication between patients and health care providers about chronic obstructive pulmonary disease (COPD) remains a major barrier to diagnosis of this disease, according to the results of a Web-based survey released on Nov. 15 by the National Heart Lung, and Blood Institute (NHLBI) of the National Institutes of Health. More Americans, particularly smokers, are talking to their doctor or health care provider about the symptoms of COPD, which is an encouraging sign that awareness efforts are taking hold. Patients and providers, though, can still do more.
   “A good conversation between patients and providers about COPD can make a real difference for disease sufferers. It’s no secret that early diagnosis and treatment can improve daily living for those who have COPD – but you can’t get there without an open line of dialogue in the exam room,” Director of the NHLBI Division of Lung Diseases Dr. James Kiley said.. “That’s why patients and providers need to be aware of COPD, its risk factors and symptoms, how it affects daily life and what can be done to help get them back to doing the things they love.”
   COPD, which in 2010 surpassed stroke to become the third leading cause of death in the United States, is a serious lung disease which over time makes it harder to breathe. It affects an estimated 24 million Americans, but as many as half of those affected remain undiagnosed. This is partially because symptoms of the disease – such as shortness of breath, chronic coughing or wheezing, production of excess sputum, or a feeling of being unable to take a deep breath – come on slowly and worsen over time, leaving many to dismiss their symptoms and delay seeking diagnosis and treatment until the disease is advanced.
   The survey found a dramatic increase in the numbers of current smokers, a key COPD risk group, who had discussed their symptoms with their doctors - from 42 percent in 2009 to 67 percent in 2013. Overall, 26 percent of adults who reported experiencing these symptoms stated they had not discussed these symptoms with their doctor or health care provider. Physicians also missed opportunities; 82 percent of current smokers who reported symptoms had a conversation with their doctor about their smoking history, but only 37 percent of former smokers, who are also at risk, reported a similar conversation.
   According to the survey, COPD awareness issues contribute to this missed dialogue. For example, three of the top reasons cited by people with COPD symptoms who did not talk to a doctor were “I did not think of it,” “I’ve had these problems for years,” and “these problems will just go way in time.” Also, only 18 percent of symptomatic people who discussed their symptoms heard their provider mention COPD.
   “Regardless of positive developments, the challenge remains that more than one in three Americans do not know what COPD is or how it affects them – and less than half understand that COPD can be treated,” said Kiley. “COPD is the only major chronic disease where deaths are not decreasing. It is critical for people to understand whether they may be at risk and recognize their symptoms as early as possible.”
   Kiley said the NHLBI will continue to lead in public education and outreach, primarily through the COPD Learn More Breathe Better campaign. COPD Learn More Breathe Better, the first national awareness campaign on COPD, aims to improve knowledge among those with and at risk for the disease, as well as health care providers – particularly those in a primary care setting. Now in 50 states and the District of Columbia, the Breathe Better Network of state and local organizations will be conducting activities and events throughout November as part of National COPD Awareness Month. The COPD Learn More Breathe Better campaign also has developed tools to facilitate discussions between providers and patients in the exam room.
   As part of the NHLBI’s broader effort to bolster the federal dialogue on COPD, the institute also recently hosted a workshop attended by representatives from 22 federal agencies and institutes invested in COPD research and education, to discuss ways to enhance the federal response to this serious public health problem. The attendees shared information about current COPD activities and identified areas where collaboration could improve disease prevention, ascertainment, diagnosis, and treatment. The representatives next aim to meet with external, non-federal stakeholders to discuss ways to respond to the growing COPD burden.
   COPD most often occurs in people age 40 and older with a history of smoking. However, as many as 1 in 6 people with COPD have never smoked. COPD also can occur in people with a genetic condition known as alpha-1 antitrypsin deficiency or through long-term exposure to substances that can irritate the lungs, such as dust or fumes.
   COPD is diagnosed with a simple test called spirometry, which can be conducted in a doctor’s office. The test involves breathing out as hard and fast as possible into a tube connected to a machine that measures lung function.
  The NHLBI analyzed the results of the annual HealthStyles survey of public health attitudes, knowledge, practices, and lifestyle habits among a nationally-representative sample of U.S. adults, conducted each year by Porter Novelli, the communications contractor for the NHLBI’s COPD Learn More Breathe Better campaign.
   The latest survey was conducted in summer 2013; results represent a sample of 4,703 U.S. adults, and have a margin of error of 1.4 percentage points. Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders.
   The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov 
   Source: National Institutes of Health