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| Credit: The Daily Independent |
In October 2016, a federal jury convicted Dr. Paulus of one count of health care fraud and ten counts of making false statements relating to health care matters, after hearing evidence that he exaggerated what he saw on patients' angiograms and then defrauded Medicare, Medicaid, and private insurers, by implanting medically unnecessary stents in his patients and falsifying the degree of stenosis in their medical records. The case was started by a complaint to the Board about the number of stent surgeries performed and their medical necessity.
After the trial, the district court granted Dr. Paulus’s motion for an acquittal. The Sixth Circuit Court of Appeals later reversed that decision, on June 25, 2018, and reinstated Dr. Paulus’s conviction, resulting in his formal sentencing. This is very unusual that a district court grants the motion for acquittal and also unusual that the conviction was reversed on appeal.
According
to evidence presented at trial, from 2008 to 2013, the government alleged that Dr. Paulus performed invasive
heart procedures on patients who did not need them. In order to justify
these unnecessary procedures, it was alleged that Dr. Paulus falsified patients’ medical records,
exaggerating their medical condition and making it appear that the heart
procedures were necessary and qualified for payment. From 2006 to 2012, Dr. Paulus billed Medicare for more heart procedures than any other cardiologist in
Kentucky, and was fifth in the nation in terms of amount paid by Medicare for
stent procedures. This was used to show that he was an outlier.
Dr. Paulus’s
sentence was based on stents he placed in seventy-one patients whose blockages
were significantly less than 70 percent, where Dr. Paulus allegedly recorded them at or near
70 percent in the records, in order to be paid for the procedures. Thus, the government contended that these were medically unnecessary procedures performed during his tenure at King’s
Daughters Medical Center in
Ashland, Kentucky.
In
addition to his term of imprisonment, Dr. Paulus must pay $1.1 million in
restitution to Medicare, Medicaid, and other private insurers.
Posted by Tracy Green, Esq.
Green and Associates
Posted by Tracy Green, Esq.
Green and Associates
