Cardiology Practice to Pay $4.75 Million Over Allegedly Unnecessary Procedures

A Phoenix-area cardiology practice and three of its physicians have agreed to pay $4.75 million to resolve allegations that they billed federal healthcare programs for medically unnecessary vein treatments, the U.S. Department of Justice announced Wednesday.

Tri-City Cardiology and doctors Jaskamal Kahlon, Joshua D. Cohen, and Marc J. Berkowitz settled claims that they violated the False Claims Act, the federal government’s primary tool for recovering funds obtained through fraudulent healthcare billing.

According to federal authorities, the physicians performed vein ablation procedures on perforator veins that did not meet accepted standards for treatment between January 2017 and April 2022. Perforator veins, which connect deeper leg veins to superficial ones, typically require intervention only under specific clinical circumstances.

The government alleged that the physicians performed these procedures despite patients not meeting the necessary clinical thresholds. Prosecutors further claimed that key indicators were “incorrectly measured or documented in patient medical records,” including blood flow duration, vein diameter, patient symptoms, and whether patients had first undergone conservative therapy.

“These documentation practices created the appearance that procedures satisfied accepted medical standards when they didn’t,” said a Justice Department spokesperson familiar with the case.

The allegedly improper claims involved submissions to multiple federal healthcare programs, including Medicare, Medicaid, TRICARE, and the Department of Veterans Affairs healthcare system. While the settlement resolves the government’s allegations, it does not constitute an admission of liability by the defendants.

Assistant Attorney General Brett A. Shumate of the DOJ Civil Division emphasized that healthcare providers participating in federal programs must adhere to recognized clinical standards. “Physicians should not prioritize profit over patient needs,” Shumate stated. “Federal programs reimburse only for treatment that meets accepted medical necessity criteria.”

Timothy Courchaine, United States Attorney for the District of Arizona, added that his office would continue pursuing recoveries where healthcare providers submit claims for procedures that fail to meet required clinical thresholds.

The investigation involved coordinated efforts between the Civil Division’s Commercial Litigation Branch, Fraud Section, the U.S. Attorney’s Office for the District of Arizona, and the Department of Health and Human Services Office of Inspector General.

Under the agreement, the defendants will pay $4.75 million, with $4,606,247.22 going to the United States and $143,752.78 to the State of Arizona. The payment includes interest calculated from January 28, 2026, at a rate of 4.25% until the settlement amount is paid in full.

While the civil settlement resolves these specific allegations, it does not release the providers from potential criminal liability or administrative enforcement actions, including possible exclusion from federal healthcare programs.

The case highlights the continuing robust enforcement of healthcare fraud laws. According to Justice Department statistics, False Claims Act settlements and judgments totaled approximately $6.88 billion in fiscal year 2025, underscoring the scale of federal fraud enforcement affecting government programs.

Healthcare-related cases remain among the largest sources of False Claims Act recoveries, with many involving improper billing practices tied to government-funded healthcare programs. Prosecutors have also pursued cases involving Medicare hospice fraud and other instances where providers allegedly billed for unnecessary services.

For healthcare organizations and compliance professionals, the Tri-City Cardiology settlement emphasizes the critical importance of accurate medical necessity documentation and robust billing controls. Medicare and other government programs reimburse only for procedures that meet recognized clinical criteria, and when medical records fail to reflect those standards accurately, providers may face False Claims Act exposure.

The case also illustrates that enforcement can extend to individual physicians responsible for clinical decision-making and documentation, not just healthcare organizations themselves.

“This settlement should serve as a reminder that healthcare providers must ensure their documentation and billing practices align with medical necessity requirements,” said a healthcare compliance expert not involved in the case. “Strong internal oversight of clinical documentation is essential for avoiding these types of allegations.”