If he settled for $2.2M, imagine how much he actually pocketed.
DAVENPORT — A Davenport doctor and his vascular surgery practice paid more than $2.2 million to settle allegations of health care fraud for filing false claims to federal health programs.
According to U.S. Attorney Maria Chapa Lopez in a media release issued by the United States Attorney’s Office Middle District of Florida, Dr. Irfan Siddiqui and the Heart & Vascular Institute of Florida in Davenport violated the False Claims Act by submitting claims from Jan. 2, 2011 to June 30, 2018 for medically unnecessary and non-Medicare reimbursable vein ablations that were up-coded to reflect they were medically necessary so the doctor and the practice would profit.
The Heart & Vascular Institute of Florida is located at 405 Lionel Way. Siddiqui, 39, is a board-certified cardiologist there.
In federal case documents filed with the U.S. District Court Middle District of Tampa, the lawsuit said the claims filed by Siddiqui and the medical practice also contained false diagnoses and symptoms, and notes the vein ablation procedures were performed by unqualified personnel, such as ultrasound technologists and therapists, and not the doctor himself.
According to court documents, Lois Hawks, 75, a former patient from Winter Haven, was the plaintiff in the case, represented by Nicholson & Eastin, LLP in Fort Lauderdale. Attorney Robert N. Nicholson said Hawks “is very grateful that the United States Attorney’s Office aggressively pursued her allegations, and that a significant recovery resulted from their efforts.”
Siddiqui’s attorney, Saqib Ishaq, did not respond to emails from The Ledger. When The Ledger called the clinic, the receptionist said she would need to transfer the call to Rudy Mercado, the office manager. The Ledger left a voicemail, and followed up with an email to Mercado. Neither was returned.
Civil court documents filed say that Hawks went to Siddiqui with pain and redness in her left ankle. She first visited Siddiqui on Oct. 14, 2014, on a referral from her podiatrist for evaluation and treatment.
In the lawsuit, Hawks alleges that she complained only of general bilateral pain in her legs and cramping. After a five-minute exam, she said the doctor was ordering a series of ultrasounds before treating her with endovenous radiofrequency ablation. That procedure closes the problem veins by intense heat directed through a catheter to the blood vessel.
Hawks asked Siddiqui why he was not physically examining her, and he said, “I can see you have a problem here,” according to court documents. The lawsuit said that Siddiqui made entries in her medical file for conditions that she didn’t have.
Court documents allege that Siddiqui “falsified these office notes to substantiate the more complex E/M visit, to support medical necessity for the RFA treatments and increase reimbursement.”
When the woman complained to the doctor of pain in her lower right leg following ablations, physical therapy was ordered, according to court records.
According to court documents, she confronted Siddiqui about the false information, and was told that he uses “a template for this type of diagnosis,” and if he doesn’t “use those diagnoses he would have a lot of people mad at him because Medicare would not pay the bill.” Court documents said Siddiqui acknowledged that the information was false and agreed to remove it.
The lawsuit also alleges that Siddiqui’s medical staff members were not qualified to perform endovenous vein ablation treatment for superficial and perforating veins.
According to the CMS Manual System, only a qualified physician is allowed to administer the ablations. Hawks received three ablation treatments, none of which was administered by Siddiqui or another qualified physician, according to court documents.
During Hawks’ final ablation procedure in March 2015, she complained of an intense burning sensation, but the procedure was not aborted, according to court records.
Hawks received $446,000 as a statutory relator’s share in the recovery.
The U.S. Attorney’s Office Middle District of Florida noted the claims resolved by the settlement are allegations only, and there has been no determination of liability.