A jury in Kentucky has found a renowned cardiologist of King’s Daughters Medical Center guilty for health care fraud after it was revealed that the surgeon had performed unnecessary invasive heart operations on numerous patients.
The cardiologist, Dr. Richard E. Paulus, has since retired from working at the hospital in Ashland, where the cardiology center bears his name. From 2006 to 2012 he charged Medicare for the most heart surgeries of any cardiologist in the state and ranked number five nationwide for the number of angioplasties (inserting a stent in the coronary artery to open it) he billed to Medicare.
Two other cardiologists in Kentucky have been convicted of similar health care fraud charges as Dr. Paulus who made $2.6 million doing this in just one year in 2011. The charges alleged that Dr. Paulus, like the two cardiologists before him, would falsify medical records in order to justify coronary procedures for patients with Medicare, like inserting stents.
A stent is a type of coil that is inserted with a balloon catheter to open a coronary artery, which is not usually necessary in a heart disease patient who is in stable condition. One patient who filed a suit against Dr. Paulus claimed that he had several stents inserted between 2006 to 2010 that were done after his condition was misrepresented and exaggerated in medical records.
The man now regularly suffers an allergic reaction to the stents that causes him to break out in hives and has led him to live with significant discomfort.
The case was investigated over the past few years by the FBI, the U.S. Department of Health and Human Services and the Medicaid Fraud and Abuse Control Unit of Kentucky, which found that Paulus operated on many patients from 2008 to 20013 who did not need the procedures done. In a class action suit filed against King’s Daughters hospital, 80 of 150 claims mentioned Dr. Paulus specifically.
Paulus’s trial lasted for nearly two months, and after ten cardiologists presented as expert witnesses stated that these procedures were not medically necessary, the jury convicted him with 11 counts of health care fraud. He will be sentenced in April and could serve up to twenty years for defrauding Medicare and up to five years for making false statements.
His lawyer, Bob Bennett, who represented Bill Clinton during the Lewinski scandal, said that they will appeal to higher courts if they must. With 21 years serving the Ashland community, Dr. Paulus had a reputation as a caring and attentive doctor.
Earlier this year another hospital from the bluegrass state, KentuckyOne Health’s St. Joseph hospital, settled two suits for health care fraud: they paid $16.5 million to the government for submitting false claims for heart surgeries to Medicare and Medicaid and another $21.2 million for scheming with cardiologists to earn profit by doing unnecessary heart operations, which was largely awarded to one plaintiff who received a pacemaker that was he did not need.
The investigation found that the hospital expected to make as much as $90 million from heart procedures and based executive bonuses on the number of operations performed.
The case with Dr. Paulus has been viewed as a success in the years’ long effort to expose fraudulent health care claims by investigators and U.S. Attorney Kerry Harvey who prosecuted the Dr. Paulus.
Personal injury attorney Chad McCoy commented, “For the patients who suffered because of these practices, this conviction may at least bring them peace of mind that the cardiologist will be held accountable for his actions.”