Acting United States Attorney W. Stephen Muldrow announced on Friday that Dr. Arthur S. Portnow, the owner and operator of Arthur S. Portnow, P.A., d/b/a Apple Medical and Cardiovascular Group, d/b/a Apple Medical Group (collectively, Dr. Portnow) has agreed to pay $1.95 million to resolve allegations that he and his practice violated the False Claims Act by knowingly seeking reimbursement for medically unnecessary ultrasound tests that were performed on Medicare beneficiaries.
The government alleges that from August 2009 through August 2017, Dr. Portnow submitted fraudulent claims to Medicare for the evaluation and performance of medically unnecessary carotid ultrasounds, lower extremity arterial ultrasounds, abdominal aortic ultrasounds, renal and renal artery ultrasounds, and echocardiograms. The government also alleges that Dr. Portnow falsified patient records in an effort to justify those unnecessary ultrasounds. Dr. Portnow and his practice received hundreds of thousands of dollars as a result of this illicit testing.
“Fraudulently billing the government for medically unnecessary tests deprives federal health care programs, like Medicare, of valuable resources,” said Acting U.S. Attorney Muldrow. “This settlement is evidence that our office will continue to pursue those who seek to unlawfully exploit our nation’s federal health care programs at the expense of patients and the Federal Treasury.”
“Physicians who seek to boost their profits by charging taxpayers and patients for medically unnecessary tests will be thoroughly investigated,” said Special Agent in Charge Shimon R. Richmond of the U.S. Health and Human Services, Office of the Inspector General. “Working in coordination with our law enforcement partners, we will continue to pursue health care professionals who threaten the integrity of Federal health care programs.”
In addition to paying the $1.95 million, as part of the settlement, Dr. Portnow has also agreed to enter into an integrity agreement with the Inspector General of the U.S. Department of Health and Human Services.
The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by a former employee (Kathleen Siwicki) of Dr. Portnow’s practice. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act that permits private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action. Ms. Siwicki will receive roughly $350,000 of the proceeds of the settlement with Dr. Portnow.
The government’s action in this matter illustrates the emphasis on combating health care fraud, and one of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). The case is captioned United States, et al. ex rel. Siwicki v. Arthur S. Portnow, M.D., et al., Case No. 8:15-cv-987-T-27MAP. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only and there has been no determination of liability.
This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida and the HHS-OIG. It was handled by Assistant United States Attorney Christopher Tuite.