United States Files Complaint Against Radnor Radiologist for Overcharging Medicare and FEHBP

United States Attorney's OfficeImage via United States Attorney's Office

PHILADELPHIA, PA — The United States has filed a complaint in U.S. District Court under the False Claims Act against Dr. James McGuckin of Radnor, PA, an interventional radiologist, and his affiliated practices and management entities. In its complaint, the United States alleges that McGuckin and his entities billed Medicare and the Federal Employees Health Benefits Program for medically unnecessary invasive peripheral artery procedures in patients’ legs between at least January 1, 2016, and December 31, 2019, and for which McGuckin and his entities were reimbursed at least $6.5 million for over 500 claims. The practice-entity defendants are: (1) Peripheral Vascular Institute of Philadelphia, LLC; (2) Main Line Vascular Institute LLC, of King of Prussia, PA; (3) Lehigh Valley Vascular Institute, LLC, of Bethlehem, PA; and (4) PA Vascular Institute, LLC, of East Stroudsburg, PA. The management-company defendants are Philadelphia Vascular Institute, LLC, and Pennsylvania Vascular Institute, P.C.

“Performing medically unnecessary procedures puts patients at risk and contributes to the soaring costs of health care, especially the invasive vascular procedures alleged in this case,” said U.S. Attorney Romero. “As this litigation demonstrates, we are committed to safeguarding federal health care program beneficiaries and protecting public funds.”

“Medicare rules are designed to protect beneficiaries and taxpayer dollars,” said Maureen R. Dixon, Special Agent in Charge of the Philadelphia Regional Office of the Inspector General, Department of Health and Human Services. “HHS-OIG and the U.S. Attorney’s Office will continue to work together to fight health care fraud and investigate allegations of co-pay and kickback violations.”  SAC Dixon added: “Anyone with information about health care fraud in this or other cases should contact the HHS-OIG hotline at 1-800-HHS-TIPS (1-800-447-8477) or online at https://oig.hhs.gov/fraud/report-fraud.”

READ:  Philadelphia Criminal Organization Charged in Postal Theft and Fraud Scheme

The allegations regarding unnecessary vascular procedures are described in detail in the complaint and include unnecessary angioplasty, atherectomy, and the placement of stents, as well as the indiscriminate use of intravenous ultrasound. Each procedure requires puncturing the skin and inserting devices into and through the arteries in patients’ legs. As the relevant standards of care indicate, unnecessary invasive vascular procedures may cause harm to patients’ health, including increasing their likelihood of needing future procedures, and putting them at greater risk of leg amputations.

As alleged, Dr. McGuckin and Defendants knew from prior administrative sanctioning that unnecessary procedures are contrary to standards of care and federal law. First, in 2015, pursuant to a Consent Decree, McGuckin was sanctioned by the Washington [State] Medical Quality Insurance Commission—and subsequently several other states’ medical boards and Medicaid programs, including Pennsylvania—for improperly performing unnecessary, experimental vascular procedures, including angioplasty and stenting, on hundreds of patients for the purported treatment of Multiple Sclerosis—a non-vascular disease.

Second, in 2018, McGuckin signed a False Claims Act settlement as manager/owner of Vascular Access Centers, L.P. (“VAC”) and related entities, which resolved multi-million dollar qui tam lawsuits in the Southern District of New York and Eastern District of Louisiana. In the settlement, McGuckin, on behalf of his entities, admitted that his entities regularly scheduled, performed, and billed for vascular procedures “even though the patients presented without any documented evidence that they exhibited a need for therapies.” More information on those prior settlements is available here: https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-announces-settlement-fraudulent-billing-claims-against-vascularhttps://www.justice.gov/usao-edla/pr/vascular-access-centers-pay-least-3825-million-resolve-false-claims-act-allegations.

Additionally, in 2019, McGuckin caused VAC to file for bankruptcy in this District—a filing that  Bankruptcy Judge Ashely M. Chan found was orchestrated in bad faith. Judge Chan found that McGuckin’s misconduct in connection with the VAC bankruptcy, including making false statements to the Court on behalf of Philadelphia Vascular Institute, LLC, subjected him to sanctions by the Court. Seee.g.In re Vascular Access Centers, L.P., 611 B.R. 742 (Bankr. E.D. Pa 2000), appeal pending.

READ:  Philadelphia Criminal Organization Charged in Postal Theft and Fraud Scheme

The current False Claims Act case is captioned United States of America ex rel. Aaron Shiloh, M.D., FSIR v. Philadelphia Vascular Institute and James McGuckin, M.D., Case No. 18-5458 (E.D. Pa.). This lawsuit was originally filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties (called relators) to sue on behalf of the government when they discover evidence that defendants have submitted false claims for government funds and to receive a share of any recovery. If the United States proves that a defendant has knowingly submitted false claims, it is entitled to recover three times the damage that resulted plus a penalty of $13,508 to $27,018 per claim. The False Claims Act also permits the government to intervene in such lawsuits, as it did when it filed a notice of intervention in this case on February 28, 2023.

The relator, Dr. Aaron Shiloh, is an interventional radiologist who worked for and with Defendants. “We sincerely thank the relator in this case. Without people like Dr. Shiloh being willing to shed light on allegations of fraud, preserving government program funds would be far more challenging,” said U.S. Attorney Romero.

The case has been investigated by the U.S. Department of Health and Human Services Office of the Inspector General. The case is being handled by Assistant U.S. Attorneys Lauren DeBruicker and Matthew E. K. Howatt, as well as Auditor Dawn Wiggins and Investigator Frank O’Connor.

All civil claims are allegations only.  There has been no determination of civil liability.

READ:  Philadelphia Criminal Organization Charged in Postal Theft and Fraud Scheme

For the latest news on everything happening in Chester County and the surrounding area, be sure to follow MyChesCo on Google News and Microsoft Start.