Cardiology Practice and Physicians Pay $4.75 Million to Settle Fraud Allegations with Justice Department

A Massachusetts-based cardiology practice and five of its cardiologists have agreed to pay $4.75 million to settle allegations of healthcare fraud, according to the U.S. Department of Justice. The settlement comes after a lengthy investigation into billing practices that allegedly violated the False Claims Act.

Merrimack Valley Cardiology Associates (MVCA), operating in the greater Boston area, was accused of systematically billing Medicare and other federal healthcare programs for services that were either unnecessary or improperly documented between 2014 and 2019.

The investigation began after a whistleblower, a former MVCA employee, filed a complaint under the qui tam provisions of the False Claims Act. According to court documents, the practice allegedly performed cardiac procedures, including certain catheterizations and vascular interventions, without adequate medical justification.

“Healthcare providers who perform unnecessary procedures and then bill federal programs not only waste taxpayer dollars but potentially put patients at risk,” said U.S. Attorney Rachael Rollins in a statement. “This settlement reflects our commitment to protect both patients and public funds from fraudulent practices.”

The five cardiologists named in the settlement—Drs. Robert Schainfeld, Michael Enright, Thomas Piemonte, David Pickul, and William Joiner—have agreed to the financial terms without admitting liability. Each physician will pay varying portions of the settlement amount based on their involvement in the alleged improper billing practices.

The settlement highlights the ongoing focus on healthcare fraud within specialty practices, particularly in high-cost areas like cardiology. The cardiology sector has faced increased scrutiny in recent years as procedures such as stent placements and diagnostic testing carry significant reimbursement rates, creating potential financial incentives for overutilization.

Industry experts note that cardiology practices nationwide are adapting to stricter compliance standards. The American College of Cardiology has responded by expanding its guidelines on appropriate use criteria for various cardiac procedures to help physicians make evidence-based decisions.

“This case demonstrates the delicate balance between clinical judgment and compliance requirements,” said Sarah Johnson, a healthcare attorney not involved in the case. “Cardiology groups must implement robust internal auditing processes to ensure they’re meeting both patient needs and regulatory standards.”

The settlement also addresses allegations that MVCA failed to properly document medical necessity for certain procedures in patient records, which is required for Medicare reimbursement. The practice has agreed to enhance its compliance program and undergo regular external audits for the next three years as part of the agreement.

The whistleblower, whose identity remains confidential, will receive approximately $855,000 from the settlement proceeds under provisions that reward individuals who report fraud against government programs.

The cardiology fraud settlement is part of a broader pattern of enforcement actions in specialty medicine. In fiscal year 2021, the Department of Justice recovered over $5.6 billion from fraud and false claims cases, with healthcare fraud accounting for the largest portion of these recoveries.

For Merrimack Valley Cardiology Associates, the settlement represents a significant financial impact but allows the practice to continue operations without criminal charges. The practice serves thousands of patients across northeastern Massachusetts and has been in operation for over 25 years.

Healthcare compliance experts emphasize that the case serves as a reminder of the importance of medical necessity documentation, particularly in procedure-heavy specialties. As reimbursement models continue to evolve toward value-based care, the scrutiny of procedural volume and appropriateness is expected to intensify.

The Department of Justice has indicated that combating healthcare fraud remains a top priority, with specialized task forces dedicated to investigating suspicious billing patterns in high-cost specialties like cardiology, orthopedics, and oncology.