United States Resolves Civil Claims That Philadelphia Cardiologist Billed Medicare For Unnecessary Stent Procedures After Voluntary Self-Disclosure

Vidya Banka, M.D., a cardiologist and former director of Pennsylvania Hospital’s cardiac catheterization lab, has entered into a civil settlement agreement with the United States to resolve allegations that he improperly submitted Medicare claims for unnecessary cardiac stent procedures.  Here is the U.S. Attorney's Office press release about this case.

The University of Pennsylvania Health System (“UPHS”), which owns Pennsylvania Hospital, brought the matter to the United States’ attention through a voluntary self-disclosure relating to conduct from 2010 to 2012. In January 2017, UPHS reached a separate settlement with the United States. The United States then continued to investigate Dr. Banka and it resulted in this settlement where he pays $126,617 and agrees to a 5 year OIG exclusion.  This is usually a civil qui tam settlement with the government and is not a criminal matter.

Voluntary self-disclosures by hospitals are obviously not a free pass for the individual providers or group providers involved and the hospital's self-disclosure did not protect the provider from exclusion.  The exclusion for a cardiologist is a tough consequence given that it will make it impossible for him to perform any procedures at any hospital that accepts Medicare or government funding for 5 years. 

Posted by Tracy Green
Green and Associates