DOJ Settlement Yields $4.7 Million from Phoenix Cardiologist

Phoenix-area cardiology practice pays $4.75 million to settle fraud allegations involving unnecessary procedures

A Phoenix-area cardiology practice and three of its physicians have agreed to pay $4.75 million to resolve allegations that they performed unnecessary medical procedures and falsified medical records to justify billing federal healthcare programs, according to the U.S. Department of Justice.

The settlement involves Tri-City Cardiology, which operates offices in Chandler, Mesa, and Gilbert, along with physicians Jaskamal Kahlon, Joshua D. Cohen, and Marc J. Berkowitz. Federal prosecutors accused the practice and doctors of violating the False Claims Act by billing Medicare, Medicaid, TRICARE, and the Department of Veterans Affairs for medically unnecessary vein ablation procedures over a five-year period from January 2017 to April 2022.

Vein ablations use heat to seal damaged veins, such as varicose veins, but according to the government, the physicians performed these procedures on patients who did not meet accepted medical standards for treatment.

In announcing the settlement, Assistant Attorney General Brett A. Shumate emphasized the ethical obligations of healthcare providers. “Physicians should not prioritize profit over patient needs,” Shumate said. “Medicare and other federal programs pay only for medical care that meets accepted standards, and the falsification of medical records undermines efforts to assess whether medical care was appropriate.”

The DOJ alleged that the defendants falsified documentation regarding blood flow duration, vein diameter, and patient symptoms to make the procedures appear medically necessary when they weren’t.

Tri-City Cardiology has firmly denied any wrongdoing. In a statement responding to the settlement, the practice said: “We strongly disagree with the government’s allegations and unequivocally deny that our physicians knowingly submitted false claims or performed medically unnecessary procedures.” The group maintains that care was provided in accordance with the 2020 Appropriate Use Criteria and Medicare’s “reasonable and necessary” standard in effect at that time.

The cardiology practice also pointed out that there were no allegations of patient harm or complaints, and that the practice remains fully eligible to participate in Medicare and all federal healthcare programs. According to Tri-City, the decision to settle was made to avoid prolonged litigation costs and to maintain focus on patient care.

U.S. Attorney Timothy Courchaine for the District of Arizona highlighted the broader impact of healthcare fraud on federal programs. “When medical providers do not respect the difference between [necessary and unnecessary care] and bill in the interest of their own bottom line instead of their patients, the United States Attorney’s Office has pursued and will continue to pursue appropriate recoveries to protect taxpayer funds,” Courchaine stated.

Healthcare fraud cases involving medically unnecessary procedures have been an enforcement priority for federal authorities in recent years. Such cases not only represent financial fraud against taxpayer-funded programs but can potentially put patients at risk by subjecting them to invasive procedures without proper medical justification.

The financial terms of the settlement specify that $4.6 million will go to the federal government, with $2.3 million designated as federal restitution. The state of Arizona will receive $144,000, with approximately $72,000 earmarked for restitution.

This case highlights ongoing concerns about potential overtreatment in the U.S. healthcare system, where fee-for-service payment models can create financial incentives for providing more services rather than focusing solely on medical necessity and patient outcomes.

The settlement with Tri-City Cardiology represents one of several recent enforcement actions targeting cardiology practices nationwide for alleged Medicare fraud involving unnecessary procedures.