Hawks v. Heart & Vascular Institute of Florida et al

COMPLAINT against Heart & Vascular Institute of Florida, Irfan Siddiqui with Jury Demand Filing fee $ 400.00, receipt number TPA-37363 filed by Lois Hawks.

Middle District of Florida, flmd-8:2016-cv-01574

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0 PageID 1 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ! ! ! ' . CASE NO .: UNITED STATES OF AMERICA, ex rel. LOIS HAWKS, Plaintiff, wuuuuuuu - jь су15ay Tзете VS. UNDER SEAL HEART & VASCULAR INSTITUTE OF FLORIDA, a Florida Professional Liability Company, and IRFAN SIDDIQUI, D. O. Individually, Defendant. COMPLAINT Plaintiff and Relator, Lois Hawks ("Relator"), brings this civil action to recover damages and civil penalties on behalf of the United States of America and against Heart & Vascular Institute of Florida, PLC, and Irfan Siddiqui, D. O. This action arises from the false statements and false claims made and presented, and caused to be made and presented, by the Defendants in violation of the Federal False Claims Act, 31U.S. C. § 3729, et seq ., as amended (the " Act") as a result of the scheme. Relator brings this action for violations of 31U.S. C. § 3729, et seq ., on behalf of herself and the United States Government and its agency, the United States Department of Health and Human Services ("HHS), Centers for Medicare and Medicaid Services ("CMS " and / or " Medicare"), pursuant to 31U.S. C. § 3730 (b) (1) . Relator has direct and personal knowledge that the Defendants have engaged in a scheme to submit false claims to the Medicare program NICHOLSON & FASTIN. LLP 707 N. E. THIRD AVENUE, SUITE 301, FORT LAUDERDALE, FLORIDA 33304 TRA _ 37363 $ 400 0 PageID 2 for medically unnecessary, upcoded and / or non - reimbursable services provided to Medicare beneficiaries. As required under the False Claims Act, 31U.S. C. § 3730 (b) (2), the Relator has provided to the Government a statement of substantially all material evidence and information related to this complaint currently in Relator's possession. This disclosure statement supports the existence of the submission of knowingly false or fraudulent claims for payment or approval, as well as the knowing, making, using, and causing to be made and used, false records or statements material to a false or fraudulent claim under the False Claims Act, in violation of 31U.S. C. $ 8 3729 (a) (1) (A) and (B) . INTRODUCTION 1. This is an action involving the routine submission of false claims to Medicare for reimbursement stemming from the provision of medically unnecessary, upcoded, and / or non reimbursable services for Medicare beneficiaries, which the Defendants made and caused to be made to Medicare from at least October 14, 2014, to in or around April 2015. The Defendants knew such claims were false and / or ineligible for reimbursement when submitted, or the Defendants submitted and caused to be submitted such claims in reckless disregard for the falsity of the claims and statements submitted, and in reckless disregard for the lack of eligibility for payment of the claims submitted. 2. The Relator in this matter is a former patient of Dr. Siddiqui and Heart & Vascular Institute of Florida and has personal knowledge regarding the False Claims Act scheme alleged herein. Specifically, Relator Lois Hawks was referred to Dr. Siddiqui by her podiatrist for evaluation and treatment of pain and redness in her left ankle. As discussed more fully infra, Ms. Hawks was a patient of Dr. Siddiqui's from October 14, 2014, to in or around April 2015, NICHOLSON & FASTIN. LLP 707 N. E. THIRD AVENUE, SUITE 301. FORT LAUDERDALE, FLORIDA 33304 0 PageID 3 during which time she was treated for superficial and perforating veins by endovenous radiofrequency ablation. 3. The Act provides that any person who knowingly submits or causes to be submitted a false or fraudulent claim to the Government for payment or approval is liable for a civil penalty of up to $ 11, 000 for each such claim submitted or paid, plus three times the amount of the false claims submitted to the Government. The Act allows any person having information regarding a false or fraudulent claim against the Government to bring an action for him or herself (the " relator") and for the Government and to share in any recovery. 4. Based on those provisions, the Relator in this case seeks to recover damages and civil penalties arising from the Defendants ' presentation of false records, false claims, and false statements to the United States Government and its agents in connection with Defendants ' claims ve for reimbursement for medically unnecessary, upcoded, non - rendered, and / or non - reimbursable services provided to beneficiaries under the Medicare program. JURISDICTION AND VENUE 5. This Court has jurisdiction over the subject matter of this action pursuant to 28U.S. C. § 1331, 28U.S. C. § 1345, and 31U.S. C. 8 3732, which specifically confer jurisdiction on this Court for actions brought pursuant to 31U.S. C. $ $ 3729 and 3730. 6. This Court has personal jurisdiction over the Defendants pursuant to 31U.S. C. S 3732 (a), which provides that, " [ a ] ny action under section 3730 may be brought in any judicial district in which the defendant, or in the case of multiple defendants, any one defendant can be found, resides, transacts business or in which any act proscribed by section 3729 occurred. " Id. Section 3732 (a) also authorizes nationwide service of process. During the relevant period, the Defendants resided in and / or transacted business in the Middle District of Florida. NICHOLSON & EASTIN, LL. P 707 N. E. THIRD AVENUE, SUITE 301, FORT LAUDERDALE, FLORIDA 33304 0 Pageld 4 7. Venue is proper in the Middle District of Florida pursuant to 28U.S. C. § 1391 (b) and 31U.S. C. § 3732 (a) because the Defendants can be found in, reside in, and or transact business within this district. PARTIES 8. Defendant Heart & Vascular Institute of Florida is a Florida limited liability company that was registered with the Florida Secretary of State on November 8, 2011, with a principal place of business of 405 Lionel Way, Davenport, Florida 33837. The registered agent for the company is Irfan Siddiqui, D. O. Heart & Vascular Institute has a NPI number of 1598042822, and it submits claims to Medicare under that number. 9. Heart & Vascular Institute specializes in cardiology and vascular medicine and recognizes itself as " Florida's cardiac care leader. " Relevant here, Heart & Vascular Institute provides endovenous ablation for treatment of varicose veins, among other things. 10. Defendant Irfan Siddiqui, D. O ., is the Managing Member and registered agent of Heart & Vascular Institute of Florida, the entity which has submitted the false claims and false statements to Medicare. Dr. Siddiqui is a doctor of osteopathic medicine specializing in cardiology and is certified to diagnose and treat disorders of the circulatory and cardiovascular system. Upon information and belief, Dr. Siddiqui is a resident of Polk County, Florida. Dr. Siddiqui is a knowing participant in the scheme to submit false claims to Medicare, and to create false statements and records material to the submitted false claims. Dr. Siddiqui has a NPI number of 1063548097, and he submits claims to Medicare through his group practice, Heart & Vascular Institute. As described herein, the Defendants engaged in a coordinated and collaborative effort to generate and submit false claims and documents to the Medicare Program for their financial benefit. NICHOLSON & FASTIN. I. LV 707 N. E. THIRD AVENUE, SUITE 301. FORT LAUDERDALE, FLORIDA 33304 0 Pageld 5 11. Relator Lois Hawks, is a resident of Florida, and a former patient of Heart & Vascular Institute and Dr. Siddiqui. The scheme alleged herein was personally witnessed by Relator Lois Hawks from October 14, 2014, to in or around April 2015, during which time Dr. Siddiqui submitted claims for upcoded evaluation and management services and ordered Ver medically unnecessary endovenous radiofrequency ablation treatments, which were performed by unqualified staff and which caused severe numbness and pain in Ms. Hawks leg, which still persists today. Sometime thereafter, Ms. Hawks became aware that Dr. Siddiqui falsified information in her medical records to support the upcoded claims and the medically unnecessary services he was ordering. 12. The United States of America is named as a Plaintiff because funds of the United States of America were and are being paid to Defendants as a result of the false claims scheme alleged in this complaint. The United States is the true party in interest in this litigation. GENERAL ALLEGATIONS A. Medicare and Reimbursement 13. Medicare is a federally - funded health insurance program for the elderly and the disabled. Medicare was created in 1965 in Title XVIII of the Social Security Act and is codified at 42U.S. C. § 301 et seq. Medicare is administered by CMS and is funded through HHS. 14. Claims submitted to Medicare for reimbursement must satisfy the requirements of the Social Security Act, as well as applicable regulations, procedures, and instructions. Providers participating in Medicare are required to familiarize themselves with all applicable laws, regulations, procedures, and instructions and to certify on each claim that it is being submitted in full compliance with governing law. Federal regulations also require providers to NICHOLSON & EASTIN, LLP 707 N. E. THIRD AVENUE. SUITE 301, FORT LAUDERDALE, FLORIDA 33304 0 PageID 6 furnish CMS, through its intermediaries, all information necessary to assure proper payment under the Medicare program. 15. Medicare has multiple " parts. " For example, Medicare Part A, the Basic Plan of Hospital Service, covers the cost of hospital and related ancillary services, such as home health agencies and skilled nursing facilities. Medicare Part B covers the cost of physician services and related ancillary services. Generally, no payments may be made under the Medicare program for expenses incurred for items and services, including drugs, that are not " reasonable and necessary " for the diagnosis and treatment of an illness or injury. See, 42U.S. C. $ 1395y (a) (1) (A) . 16. CMS issues national coverage determinations ("NCDs") that specify whether certain items, services, procedures or technologies are " reasonable and necessary " under $ 1862 (a) (1) (A) of the Act. 17. In the absence of or in addition to a NCD, CMS's regional fiscal intermediaries known as Medicare Administrative Contractors ("MACS") are responsible for creating and implementing Local Coverage Determinations ("LCDs") . A LCD, as defined by the Social Security Act, " means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary or carrier - wide basis under such parts, in accordance with section § 1862 (a) (1) (A) . " See Section $ 1869 (1) (2) (B) of the Social Security Act. 18. At all times relevant to this complaint, Medicare contracted with multiple entities to process claims for medical services and treatment. Relevant here, First Coast Service Options (hereinafter " FCSO"), which is the regional contractor for the Southeast United States, was and is responsible for processing and payment claims, as well as publishing LCDs regarding NICHOLSON & EASTIN, LLP 707 N. E. THIRD AVENUE. SUITE 301. FORT LAUDERDALE, FLORIDA 33304 0 Pageld 7 coverage criteria and documentation requirements for certain services, such as those at issue in this case. Heart & Vascular Institute and Dr. Siddiqui were required to and did submit Medicare claims for payment to FCSO for the services provided to Medicare beneficiaries. FCSO would then request payment from the United States on behalf of Defendants and forward payment to Heart & Vascular Institute. B. Evaluation and Management Services 19. Evaluation and management codes ("E / M") are use to report evaluation and management services provided in the office or in an outpatient or other ambulatory facility. See CPT Code Book, Professional Edition, American Medical Association (2014) . The specific CPT code billed is dependent on whether he / she is a new or establi