Dr. Qamar; Institute of Cardiovascular Excellence.

[shrink]

Approximately 2 years ago, I placed a post on TOTV suggesting that people avoid seeing a particular cardiologist doing business in The Villages (and elsewhere) who was performing unnecessary procedures. I described the operation, but was reluctant to disclose his name (due to liability concerns). I received several replies to this post, many of which were critical of my perceptions. Tonight on local channel 9, WFTV in Orlando, Dr. Asad Qamar was highlighted as being sued by attorney John Kroner (out of Miami) by a "whistleblower" client. The suit is a multi-million dollar one, claiming Medicare fraud and the performing of multiple unnecessary and life-threatening procedures on patients. The report stated that in 2012, (the year my husband was "treated"..who by the way, has NO cardiac condition of any kind), Dr. Qamar took in over $18,000,000 from Medicare, making him the highest paid cardiologist in the nation. My husband is still having side effects from an unnecessary cardiac cath that was performed by this "doctor". I am putting this post up for public awareness. Thank you. Be aware.

[Carla B]

I recall your former post and am happy you're finally able to reveal the name. I read the article about Dr. Qamar today in the Daily Sun and also several other sources on line. My husband was seeing one of the internists in that practice until recently, though not for cardiology.

[graciegirl]

I recall your former post and am happy you're finally able to reveal the name. I read the article about Dr. Qamar today in the Daily Sun and also the Ocala paper. My husband was using one of the internists in that practice until recently, though not for cardiology. Didn't Dr. Qamar bill Medicare $18 million in one year, rather than COLLECT $18 million? Still a huge sum.


Did I hear them say on TV news last night that he was the highest earning cardiologist in the whole country?????? Am I right on that?

[janmcn]

Dr. Qamar collected $18 million in 2012, according to the DOJ investigation, the second highest in the country. This according to the on-line news.

[Carla B]

Did I hear them say on TV news last night that he was the highest earning cardiologist in the whole country?????? Am I right on that?

Yes, that's correct, as far as Medicare payments. The highest paid doctor at $21 million for 2012 is an ophthalmologist, also practicing in Florida.

[zonerboy]

Gotta pay for all those multi full page ads in all the local spiffy magazines somehow.

[Shimpy]

Approximately 2 years ago, I placed a post on TOTV suggesting that people avoid seeing a particular cardiologist doing business in The Villages (and elsewhere) who was performing unnecessary procedures. I described the operation, but was reluctant to disclose his name (due to liability concerns). I received several replies to this post, many of which were critical of my perceptions. Tonight on local channel 9, WFTV in Orlando, Dr. Asad Qamar was highlighted as being sued by attorney John Kroner (out of Miami) by a "whistleblower" client. The suit is a multi-million dollar one, claiming Medicare fraud and the performing of multiple unnecessary and life-threatening procedures on patients. The report stated that in 2012, (the year my husband was "treated"..who by the way, has NO cardiac condition of any kind), Dr. Qamar took in over $18,000,000 from Medicare, making him the highest paid cardiologist in the nation. My husband is still having side effects from an unnecessary cardiac cath that was performed by this "doctor". I am putting this post up for public awareness. Thank you. Be aware.

Had you given his name back then maybe many people on this board could have avoided him. I understand your reason though and would have done the same thing to protect myself from lawsuit knowing how flawed our court system is.

[gerryann]

Yes, that's correct, as far as Medicare payments. The highest paid doctor at $21 million for 2012 is an ophthalmologist, also practicing in Florida.

The optomologist was Dr Salomon Melgen from West Palm. I don't believe he has practiced in the villages, but may be wrong.

[graciegirl]

The optomologist was Dr Salomon Melgen from West Palm. I don't believe he has practiced in the villages, but may be wrong.


Do these doctors come from other countries to fleece us?

[dbussone]

Do these doctors come from other countries to fleece us?


GG - IMO, they come from different cultures. In some, ethics are not what we would wish for. I know this is not PC. The good side is that I have a couple of physicians who are not from the US, but have trained here and are absolutely first rate. On the other hand, there are others who are not.

[pbkmaine]

Some MDs and medical groups have figured out how to manipulate the system to their financial advantage. My oldest friend, an OB/GYN, absolutely hated the pressure she was under by her employer to see as many patients and do as many procedures as possible. She worked for a hospital system and reported not to another MD, but to a business type who was only interested in her "productivity metrics". She ended up taking early retirement to save her sanity. The Mayo Clinic model, which rewards MDs based on outcomes instead of "productivity metrics", is so much better. I would like to see it everywhere.

[dbussone]

Some MDs and medical groups have figured out how to manipulate the system to their financial advantage. My oldest friend, an OB/GYN, absolutely hated the pressure she was under by her employer to see as many patients and do as many procedures as possible. She worked for a hospital system and reported not to another MD, but to a business type who was only interested in her "productivity metrics". She ended up taking early retirement to save her sanity. The Mayo Clinic model, which rewards MDs based on outcomes instead of "productivity metrics", is so much better. I would like to see it everywhere.


Well the Mayo clinic local facilities are not what you think. They move into an area, market and establish a preliminary presence and largely recruit non-Mayo docs for the new facility. That is their model for expansion. They market their name but not what you necessarily expect.

[sunnyatlast]

Q: Why has this "Dr." Qamar billed and abused our tax-funded Medicare system like a charlatan?

A: Because he COULD.

CMS has known for a long time what this guy was/is doing. And there are many other crooks billing Medicare just like he does across across the country.

The magnitude of this abuse of taxpayer-funded public health insurance is so huge that to me, it is absurd to want this same monstrous type of system across the board for everyone to be under a government single payer system!

Consider:

"The true annual cost of fraud and abuse in health care is not known. In fiscal year 2011 Medicare spent $565 billion on behalf of its 48.7 million beneficiaries, while federal and state Medicaid agencies served 70 million people at a combined cost of $428 billion. CMS estimated that in fiscal year 2010 these two programs made more than $65 billion in "improper federal payments," defined as payments that should not have been made or were made in an incorrect amount. Adding in improper payments made by state Medicaid programs boosts the total by about $10 billion annually.

UNDERSTANDING THE PROBLEM: CMS's estimate of improper payments, which relies on random samples of claims data, is widely thought to understate the true size of the problem of fraud and abuse. In an April 2012 study former CMS administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that fraud and abuse added as much as $98 billion to Medicare and Medicaid spending in 2011.

For many years, the Government Accountability Office (GAO), the investigative arm of Congress, has designated Medicare and Medicaid as being at "high risk" for fraud, abuse, and improper payments. Both programs were designed to enroll "any willing provider" and to reimburse claims quickly for services provided.

The programs today handle an enormous volume of transactions, making it easier for dubious claims to escape detection. Every business day, for example, Medicare administrative contractors process about 4.5 million claims from 1.5 million providers. Every month, they process 30,000 enrollment applications from health care providers and suppliers of medical equipment.

The emphasis on rapid payment, as opposed to identifying and rooting out false or inflated claims, makes both programs susceptible to fraud. Taking advantage of this weakness, for example, Eastern European crime syndicates have lately become prevalent players in Medicare fraud, specializing in stealing the identifies of Medicare and Medicaid beneficiaries, and then billing the programs for treatments that didn't take place at clinics that don't exist.

The magnitude of potential wrongdoing is such that resource-strapped federal prosecutors have adopted an unofficial threshold that requires that alleged crimes be worth at least $500,000 and be clear cut enough to make conviction a near certainty before they will take up a case. That leaves a lot of room for marginal operators to game the system for many multiples of much smaller sums….."

Health Policy Briefs (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=72)

…

[shrink]

Q: Why has this "Dr." Qamar billed and abused our tax-funded Medicare system like a charlatan?

A: Because he COULD.

CMS has known for a long time what this guy was/is doing. And there are many other crooks billing Medicare just like he does across across the country.

The magnitude of this abuse of taxpayer-funded public health insurance is so huge that to me, it is absurd to want this same monstrous type of system across the board for everyone to be under a government single payer system!

Consider:

"The true annual cost of fraud and abuse in health care is not known. In fiscal year 2011 Medicare spent $565 billion on behalf of its 48.7 million beneficiaries, while federal and state Medicaid agencies served 70 million people at a combined cost of $428 billion. CMS estimated that in fiscal year 2010 these two programs made more than $65 billion in "improper federal payments," defined as payments that should not have been made or were made in an incorrect amount. Adding in improper payments made by state Medicaid programs boosts the total by about $10 billion annually.

UNDERSTANDING THE PROBLEM: CMS's estimate of improper payments, which relies on random samples of claims data, is widely thought to understate the true size of the problem of fraud and abuse. In an April 2012 study former CMS administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that fraud and abuse added as much as $98 billion to Medicare and Medicaid spending in 2011.

For many years, the Government Accountability Office (GAO), the investigative arm of Congress, has designated Medicare and Medicaid as being at "high risk" for fraud, abuse, and improper payments. Both programs were designed to enroll "any willing provider" and to reimburse claims quickly for services provided.

The programs today handle an enormous volume of transactions, making it easier for dubious claims to escape detection. Every business day, for example, Medicare administrative contractors process about 4.5 million claims from 1.5 million providers. Every month, they process 30,000 enrollment applications from health care providers and suppliers of medical equipment.

The emphasis on rapid payment, as opposed to identifying and rooting out false or inflated claims, makes both programs susceptible to fraud. Taking advantage of this weakness, for example, Eastern European crime syndicates have lately become prevalent players in Medicare fraud, specializing in stealing the identifies of Medicare and Medicaid beneficiaries, and then billing the programs for treatments that didn't take place at clinics that don't exist.

The magnitude of potential wrongdoing is such that resource-strapped federal prosecutors have adopted an unofficial threshold that requires that alleged crimes be worth at least $500,000 and be clear cut enough to make conviction a near certainty before they will take up a case. That leaves a lot of room for marginal operators to game the system for many multiples of much smaller sums….."

Health Policy Briefs (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=72)

…
I believe you are 100% correct about everything you had to say. For one thing, I submitted a fraud claim against Dr. Qamar in 2012. I noticed on my Medicare statement that Qamar had billed for both a treadmill and a chemical stress test. I never had a treadmill test (nor was I offered one, as the chemical stress test was far more lucrative for the practice). The Medicare Fraud rep with whom I spoke told me that I might not be informed of the status of my complaint, as there was already an ongoing investigation of this practice! What??? To make matters worse, apparently some years ago, Dr. Qamar was under investigation by Medicare, with the concerns being "founded". None the less, he was allowed to continue to practice and to bilk the system of multiple millions of dollars, not to mention the harm he did to perhaps thousands of patients who underwent unnecessary procedures. When I tried to talk with the Medicare rep about the unnecessary procedures (as spelled out by our second opinion cardiologist), I was told there was "nothing that Medicare could do about the tests that a licensed physician chooses to order", and that the only report that they could file was if a procedure was billed that hadn't actually been done!

On another note in reference to your post, up North, the husband of my closest friend is an ER doctor in a mid-sized community hospital. He has been brought in on the carpet (and in fact, threatened with loss of employment) because he was judged to be too thorough, and thus, not turning patients over fast enough. Because the hospital is urban, many of the patients who come in are drug seeking. My friend's husband was told repeatedly not to waste time checking the drug registries, but to give the patients a short supply of narcotics and get them out of there. I realize this is an entirely different scenerio from the Qamar deal, but reflects some of the pressures that undermine a functional health care system.

[sunnyatlast]

I believe you are 100% correct about everything you had to say. For one thing, I submitted a fraud claim against Dr. Qamar in 2012. I noticed on my Medicare statement that Qamar had billed for both a treadmill and a chemical stress test. I never had a treadmill test (nor was I offered one, as the chemical stress test was far more lucrative for the practice). The Medicare Fraud rep with whom I spoke told me that I might not be informed of the status of my complaint, as there was already an ongoing investigation of this practice! What??? To make matters worse, apparently some years ago, Dr. Qamar was under investigation by Medicare, with the concerns being "founded". None the less, he was allowed to continue to practice and to bilk the system of multiple millions of dollars, not to mention the harm he did to perhaps thousands of patients who underwent unnecessary procedures. When I tried to talk with the Medicare rep about the unnecessary procedures (as spelled out by our second opinion cardiologist), I was told there was "nothing that Medicare could do about the tests that a licensed physician chooses to order", and that the only report that they could file was if a procedure was billed that hadn't actually been done!

On another note in reference to your post, up North, the husband of my closest friend is an ER doctor in a mid-sized community hospital. He has been brought in on the carpet (and in fact, threatened with loss of employment) because he was judged to be too thorough, and thus, not turning patients over fast enough. Because the hospital is urban, many of the patients who come in are drug seeking. My friend's husband was told repeatedly not to waste time checking the drug registries, but to give the patients a short supply of narcotics and get them out of there. I realize this is an entirely different scenerio from the Qamar deal, but reflects some of the pressures that undermine a functional health care system.

Thank you. So in other words, abusers are not only allowed, but they are facilitated in running roughshod over the Medicare and Medicaid fraud detection and enforcement agents, to wreck the system for the innocent elderly and disabled--the weakest among us.

When is somebody in charge going to admit that for every fraudulent billion dollars squandered, it's a billion that did NOT get used to pay for those who need the insurance, and it's another billion that the shrinking taxpayer base will have taken out of its hide AGAIN??

[bimmertl]

Can't only blame people from foreign countries for fleecing Medicare. A few years back Columbia/HCA paid a 1.7 billion dollar fine for Medicare fraud and plead guilty to 14 corporate felonies. While the fraud was being committed it was run by a US born citizen and Navy veteran.

[janmcn]

Can't only blame people from foreign countries for fleecing Medicare. A few years back Columbia/HCA paid a 1.7 billion dollar fine for Medicare fraud and plead guilty to 14 corporate felonies. While the fraud was being committed it was run by a US born citizen and Navy veteran.


At the time this was the largest case of Medicare fraud in the history of Medicare.

[Challenger]

I know for a fact the names of three doctors who have been found guilty of Medicare fraud who are now practicing in TV. They have all movde here from other communities where their misdeeds started .

Always Google any new provider. Try yours now , some of you will be quite shocked.

[graciegirl]

I know for a fact the names of three doctors who have been found guilty of Medicare fraud who are now practicing in TV. They have all movde here from other communities where their misdeeds started .

Always Google any new provider. Try yours now , some of you will be quite shocked.


Why is this not public knowledge? You cannot find some of the arrest records of some local MD's either. Can you arrange to have them removed from public media and internet?

THAT is JUST not right.

[Villages PL]

I have always said that healthcare is a business and doctors/clinics are in business to make money. And just as with any other business, some will be honest and some not.

If doctors are squeezed by Medicare & Medicaid into accepting less money for their services, that may be the tipping point that starts them down the wrong path. Of course that doesn't justify their actions, I'm just saying it might be a contributing factor in some cases as some doctors may feel cheated by the system.

[janmcn]

I have always said that healthcare is a business and doctors/clinics are in business to make money. And just as with any other business, some will be honest and some not.

If doctors are squeezed by Medicare & Medicaid into accepting less money for their services, that may be the tipping point that starts them down the wrong path. Of course that doesn't justify their actions, I'm just saying it might be a contributing factor in some cases as some doctors may feel cheated by the system.

All doctors have a choice of accepting Medicare and Medicaid or going another route. Nobody is forcing them to accept less money.

By these recent examples, it seems that The Villages attracts the rotten apples probably because of the elderly population who will accept any test ordered.

[blueash]

I know for a fact the names of three doctors who have been found guilty of Medicare fraud who are now practicing in TV. They have all movde here from other communities where their misdeeds started .

Always Google any new provider. Try yours now , some of you will be quite shocked.

And here is the law regarding Medicare fraud and ongoing participation in Medicare / Medicaid

Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

The effect of an exclusion is that no payment will be made by any Federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else. The exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the excluded person.





There is no misinterpretation of that requirement. A person subsequent to such penalty does have the option to appeal for reinstatement. I have no idea about the typical length of the exclusion but believe it is related to the severity of the fraud. Nor do I have data on how often a request for reinstatement is granted. However, I would ask that the names of persons who are excluded from Medicare who are now practicing in the Villages, as alleged, be given to us. Fraud is a major concern and if there are practitioners practicing here who have been prohibited from Medicare participation, neither they, nor their group practice, nor their hospital can bill for that provider's services. Who are these three doctors who you know as a fact to have been found guilty of Medicare fraud? There is no concern for liability in giving us those names as truth is a defense against libel. Additionally all suspensions from Medicare as well as convictions for fraud are already public record. You may post links to the stories of their convictions if you decline to name these fraudsters yourself.

The recently enacted ACA (Obamacare) has a provision increasing the budget for detecting and prosecuting Medicare fraud. I hope (opinion) it is very successful. If you have a doctor who is waiving your Medicare copay, that may be fraud. If you are getting billed for a test you didn't need or even worse never had done, that may be fraud. Sometimes someone just clicks in the wrong place on a superbill so not all errors are fraud, but all need to be reported to clean up the problem.

Reporting fraud | Medicare.gov (http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/reporting-fraud.html)

[Bethinflorida]

Do these doctors come from other countries to fleece us?


Did Bernie Madoff come from a different country?

[Villages PL]

All doctors have a choice of accepting Medicare and Medicaid or going another route. Nobody is forcing them to accept less money.

By these recent examples, it seems that The Villages attracts the rotten apples probably because of the elderly population who will accept any test ordered.

Sometimes doctors don't have a choice because they are just starting a new practice and don't have enough patients.

[dbussone]

Sometimes doctors don't have a choice because they are just starting a new practice and don't have enough patients.

Poppycock!

[janmcn]

Sometimes doctors don't have a choice because they are just starting a new practice and don't have enough patients.

Poppycock!


And I would add, these are not struggling new doctors who are getting caught with their hands in the cookie jar. These are seasoned professionals who have learned the tricks of the trade.

[Paper1]

As long as someone else is "picking up the tab" this fraud will continue. Until the users of health care services have real skin in game, this type of crime will continue. I would offer we should empty our jails of all none violent drug offenders and fill up with our "white collars" type criminals as the are doing much more damage to our country than the drug user.

[nicoletta]

they joined together but it didn't work out wonder why ?/...greed::: pure unadulterated greed look up your dr type the name and see how many lawsuits ...there are several for unqualified staff to the point of causing physical harm wrong meds dosage way to much tax invasion for husband etc etc ethic is right they have NONE ..pay attention fyi for you benefit
Department of Justice

U.S. Attorney’s Office

Middle District of Florida



FOR IMMEDIATE RELEASE



Friday, December 12, 2014

United States Settles False Claims Act Allegations Against Florida-Based Sleep Clinic And Physician For $250,000








Jacksonville, FL B The United States has settled a lawsuit against a central Florida-based sleep clinic for submitting false claims to the government. The qui tam or “whistleblower” complaint, filed by a former employee of the clinic, alleges that VMG Pulmonary and Sleep Institute and its physician/owner, Dr. Marivic Villa, violated the False Claims Act (FCA) by intentionally billing the government for hundreds of thousands of dollars of services that were not medically necessary, and that were performed by unlicensed, uncredentialed, and unsupervised employees.

The government announced today that it had reached a settlement with VMG and Dr. Villa. In reaching this settlement, the parties resolved allegations that, from January 1, 2009, until November 2012, Dr. Villa owned and operated sleep clinics in The Villages that were staffed by unlicensed and unsupervised employees. In many instances, these employees lacked the basic knowledge regarding the tests that they were performing. Despite Medicare payment rules that require that polysomnographic (PSG) tests be conducted by appropriately credentialed employees, the government contends that Dr. Villa only employed non‐credentialed employees. The government also contends that Dr. Villa continued to seek payment for claims to Medicare and TRICARE when she knew, or should have known, that she was violating the payment requirement by not having any appropriately credentialed employees administering PSG tests to beneficiaries. VMG and Dr. Villa agreed to pay $250,000 to resolve the claims.

"The United States Attorney's Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud," said United States Attorney A. Lee Bentley, III. "By bringing FCA cases such as this, we hope to recover funds obtained through the fraud and deter others from attempting similar schemes."

This lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act by Donald Nichols, a former employee at the clinic. Under those provisions, a private party, known as a relator, can file an action on behalf of the United States and receive a portion of the recovery. Nichols will receive more than $50,000 as part of today’s settlement.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Department of Justice has recovered a total of more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.

This case was investigated by the U.S. Department of Health and Human Services - Office of Inspector General (HHS/OIG), the Defense Health Agency (DHA), HHS Office of Counsel to Inspector General (HHS/OCIG), and handled by Assistant United States Attorney Jason Mehta.

The claims resolved by this settlement are allegations only, and there has been no determination of liability. The lawsuit against the defendants was filed in the U.S. District Court for the Middle District of Florida and is captioned United States ex rel. Nichols v. VMG Pulmonary and Sleep Institute, Tri-County Pulmonary & Multi-Specialty Group, and Dr. Marivic Villa.

[nicoletta]

for every lie there are ten more unseen

certain people know the truth