Dr. Elie Korban ran his own clinic as a cardiologist in Jackson and Lexington, Tenn. This month, he was charged with billing Medicaid and Medicare for heart procedures that were deemed medically unnecessary, the Justice Department announced on Dec. 19.
The cardiac operations consisted of placing stent tubes, or mesh tubes, used to in the coronary arteries of patients to keep their arteries from closing during the heart disease treatments. From 2005 through 2008, Korban allegedly put these tubes in patients when they were not required. The Justice Department reports he will pay $1.15 million back to settle allegations.
"This case is one of many that underscores our commitment to holding accountable those who would cheat the health care system for their own personal profit," U.S. Attorney for the Western District of Tennessee Edward Stanton said in a Department of Justice press release. "We will continue to vigorously protect citizens from schemes that damage the ability of health care providers and patients to participate in a system free of false claims and dishonesty."
Korban's scheme was exposed by Dr. Wood Deming who, under the whistleblower provisions of the False Claims Act, filed a lawsuit against Korban. As part of the settlement, Deming will receive a share of the settlement amount.
"Too many recent frauds involve medically unnecessary heart stents," Derrick Jackson, special agent in charge at the U.S. Department of Health and Human Services Office, explained in the release. "Providers are warned that they can be aggressively investigated and held accountable for falsely billing federal health programs."
The settlement marks a victory for the Health Care Fraud Prevention and Enforcement Action Team. Since the beginning of 2009, a staggering total of more than $17 billion have been recovered by the agency, with more than $12.2 billion of that amount from cases involving fraud against federal health care programs.
Second opinions matter
This Tennessee case acts as another reminder that patients should get a second opinion from another doctor before moving forward with a major surgery. Not only could it save you thousands of dollars in insurance costs but it might taper down abuse on the Medicaid and Medicare system.
If you suspect any fraudulent activity by a health care provider, medical equipment supplier, pharmacist or any other individual, be sure to contact your state's Medicaid agency.