False Claims Act Judgment Entered Against Washington, DC, Health Care Provider for More Than $17 Million

The U.S. District Court for the District of Columbia has entered judgment for more than $17 million against Dr. Ishtiaq Malik and his two companies, Ishtiaq Malik M.D., P.C. and Advanced Nuclear Diagnostics, for submitting false nuclear cardiology claims to federal and state health care programs, the Justice Department announced today. Ishtiaq Malik, a nuclear cardiologist, has practiced in the District of Columbia metropolitan area since 2002.

“Physicians who participate in government health care programs must bill for their services accurately and honestly,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. “The Department of Justice is committed to pursuing those physicians who seek financial gain at the expense of taxpayer-funded programs.”

The government’s allegations focused on Dr. Malik’s inappropriate claims for myocardial perfusion studies, commonly referred to as nuclear stress tests. These diagnostic imaging studies determine whether a patient has heart disease due to inadequate blood flow to the heart muscles. The test is usually performed in two separate phases: stress and rest. The two phases, which can be conducted on the same day or separate days, must be coded and submitted as one test. The government alleged that, contrary to these requirements, Dr. Malik and his companies double-billed for multi-day nuclear stress test studies.

“This doctor fraudulently diverted critical resources from government health care programs, contributing to the rising cost of health care for all Americans,” said Ronald C. Machen Jr., U.S. Attorney for the District of Columbia. “This lawsuit was designed to hold the doctor to account for bilking the taxpayer. We will do everything in our power to obtain every cent of the $17 million this doctor now owes the American people.”

The government alleged that Dr. Malik submitted false claims to Medicare, District of Columbia Medicaid, Maryland Medicaid, TRICARE and the Federal Employees Health Benefits Plan. In addition, the government alleged that Dr. Malik and his companies billed under codes that did not apply to the nuclear stress test studies he administered and billed for services already included in the payment for nuclear stress test codes, such as intravenous injections, drug infusions, 3D rendering and drug administration. He and his companies also allegedly billed for services not performed.

“Federal employees deserve health care providers who meet the highest standards of ethical and professional behavior,” said Patrick E. McFarland, Inspector General of the U.S. Office of Personnel Management. “This judgment reminds health care providers that they must observe those standards and reflects the commitment of federal law enforcement organizations to pursue improper and illegal conduct that places the health care system at risk.”

“Dr. Malik fraudulently charged for his services and taxpayers deserve protection from such scams,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “OIG agents, working with other law enforcement agencies, conducted interviews, gathered records and analyzed data to conclude a successful investigation and bring the doctor to justice.”

The government filed suit against Dr. Malik and his two companies under the False Claims Act, which allows the government to recover three times its damages, plus penalties, from those who submit false claims for federal funds. The state of Maryland and the District of Columbia subsequently joined the lawsuit under their respective state false claims acts.

This civil lawsuit illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $14.7 billion through False Claims Act cases, with more than $10.7 billion of that amount recovered in cases involving fraud against federal health care programs.

This investigation was a cooperative effort among the Commercial Litigation Branch, Civil Division, Department of Justice; the U. S. Attorney’s Office for the District of Columbia; the Maryland Attorney General’s Office; and the Attorney General’s Office for the District of Columbia. The Department of Health and Human Services’ Office of the Inspector General and the Office of Personnel Management’s Office of the Inspector General assisted in the investigation. The lawsuit is United States of America et al. v. Malik et al., No. 1:12-01234-RLW (D.D.C.).