by Brian Mahany
This post is being written from the Pittsburgh International Airport. While waiting for my flight I purchased a copy of the Pittsburgh Post-Gazette to read about the death of Joe Paterno. In addition to the many stories on the life and death of “Joe Pa” was this headline, “Doctors at Erie Practice Accused of Unnecessary Surgery.” While stories of fraud are sadly far too frequent in today’s press, this one discussed the actions of a physician with the courage to stand up and blow the whistle about health care fraud and unnecessary surgeries at his former work place.
Intrigued by the story, I researched the court records to lean more.
The case was filed by Dr. Tullio Emanuele, a former cardiologist at Medicor and Hamot Medical Center (now part of UPMC, a health care system covering 1,000,000 in New York, Ohio and Pennsylvania). Dr. Emanuele claims his colleagues performed cardiac and vascular surgical procedures that were not medically necessary or overbilled for those services.
The case is filed under the federal False Claims Act also known as the “Lincoln law” or a whistleblower complaint. That law allows concerned citizens to file a lawsuit in the name of the United States if the person believes federal tax dollars were wasted as the result of false billing. In this case, Dr. Emanuele says that Medicare funds were used for many of these unnecessary surgical procedures.
While the fraud to taxpayers is certainly bad enough, medical false claims case are particularly outrageous because of the physical harm – or even death – that it causes to the patients. How would you feel if you went to see your doctor and were told you needed to be “opened up” or have a cardiac catheterization, only to later learn that the doctors did this just to make some extra cash?
Experts have long said that many cardiac procedures are unnecessary. Absent someone on the inside, however, it’s hard to second guess the treating physician. What often results is a code of silence. The medical risks from an unnecessary X-Ray are much lower than an unneeded cardiac catheterization, however.
Although this case was filed over a year ago, it was just unsealed by the court last fall. The defendants have yet to answer the complaint so we don’t know their side of the story yet. What we do know is that physicians and other health care professionals are coming forward in increasing numbers and speaking out about unnecessary surgeries and phony billing.
Health care costs are already beyond the reach of many Americans. When a hospital or doctor overbills just to make more money we all suffer.
If you know of fraud in the health care industry, give us a call. The fraud lawyers at Mahany Law are currently co-counsel with the government in one of the largest whistleblower cases in the nation, the $2.4 billion fraud case filed against Allied Home Mortgage Company. We understand that not every case is a billion dollar case but fraud is fraud and we work hard to help stamp it out.
Whistleblowers are entitled to a percentage of any monies recovered by taxpayers. Whether Dr. Emanuele filed this case to make money or to do the right thing, we don’t know. We suspect that like most whistleblowers, he simply refused to tolerate fraud in the workplace any longer.
We salute Dr. Emanuele and all the other men and women who come forward every day to report fraud.
If you have information or wish to participate in a whistleblower suit, give us a call. All inquiries are strictly confidential. For more information contact attorney Brian Mahany at (direct dial) or by email at .
Not ready to call? Visit our Medicare fraud whistleblower information page. (We have 400 healthcare fraud related posts on our site. Use the search feature on our blog to search for more information.)