According to a Department of Justice press release issued Wednesday, December 7, 2016, South Miami Hospital, a not-for-profit regional hospital located in South Miami, Florida has agreed to pay the United States approximately $12 million to settle allegations that it billed federal healthcare programs for medically unnecessary cardiac procedures.  The unnecessary procedures were allegedly performed by John R. Dylewski, M.D, a physician at South Miami Hospital, for the sole purpose of increasing reimbursements.

The allegations arose from a lawsuit filed by two whistleblowers James A. Burks, M.D., and James D. Davenport, M.D., under the qui tam provisions of the False Claims Act.  Dr. Burks is a board-certified vascular surgeon and medical doctor who began his practice as a vascular surgeon at South Miami Hospital in 2003.  Dr. Davenport is a board-certified cardiologist and medical doctor, who was an active member of various peer review committees at South Miami Hospital between 2010 and 2014.

The Physicians alleged Dr. Dylewski and South Miami Hospital engaged in a number of unnecessary cardiac procedures, including echocardiograms, electrophysiology studies, head upright tilt tests, and other treatments of arrhythmia by ablation, cryoablation, or implantation of an electronic device, for the sole purpose of increasing the amount of physician and hospital reimbursements paid by Medicare and other federally-funded programs.

Under the qui tam provisions of the False Claims Act, private citizens can bring a lawsuit on behalf of the government and are entitled to share in any recovery.  The False Claims Act allows the government to recover up to three times the amount fraudulently billed by the defendants as well as monetary penalties ranging from $10,781.40 and $21,562.80 for each false claim.   Private citizens who bring cases on behalf of the government are known as relators and are entitled to receive between 15-30 percent of the government’s recovery as well as their attorney’s fees.  In this case, Drs. Burks and Davenport will receive approximately $ 2,748,500.

For more information about the qui tam provisions of the False Claims Act, click here.