2021-03-08 DOJ SDNY press_release 120 KB 7,073 chars

Manhattan U.S. Attorney Announces Resolution Of Civil And Criminal Healthcare Fraud Charges Against Vascular Surgeon For Fraudulently Billing Medicare For Medically Unnecessary Procedures

summary

Dr. Feng Qin fraudulently billed Medicare for medically unnecessary vascular procedures on end-stage renal disease patients between 2015 and 2016, falsifying medical records to justify claims, and as a result agreed to pay $800,000 in restitution, accept a four-year federal healthcare ban (plus over two years already served), and face deferred criminal prosecution with potential dismissal if he complies for one year.

paragraph

Dr. Feng Qin and his practice, QIN MEDICAL P.C., resolved civil and criminal healthcare fraud charges by agreeing to pay $800,000 in total restitution—$783,200 to the federal government and $16,800 to New York State—for billing Medicare for unnecessary fistulagrams and angioplasties on ESRD patients from 2015 to 2016. Qin routinely performed these procedures without clinical justification, falsifying patient records to misrepresent symptoms and conceal that the services were not covered under Medicare guidelines. He also admitted to prior fraud, having paid $150,000 in a 2010–2012 settlement, and is now excluded from federal healthcare programs for four years, with criminal charges deferred for one year pending compliance.

narrative

Dr. Feng Qin, a vascular surgeon practicing in Lower Manhattan and Far Rockaway, Queens, fraudulently billed Medicare for medically unnecessary vascular procedures—including fistulagrams and percutaneous transluminal angioplasties—on end-stage renal disease (ESRD) patients between 2015 and 2016, despite Medicare rules requiring documented clinical justification. He routinely scheduled these procedures every three months for all ESRD patients regardless of medical need, and falsified medical records to falsely indicate symptoms such as dialysis access problems that would justify the interventions. QIN MEDICAL P.C. then submitted false claims to Medicare, which paid for procedures explicitly excluded from coverage under these circumstances. As part of the resolution, Qin and his practice agreed to pay $800,000 in total restitution: $783,200 to the federal government and $16,800 to New York State, based on their financial capacity. Qin previously paid $150,000 to settle a similar fraud case from 2010 to 2012 and has now accepted a four-year exclusion from federal healthcare programs, adding to over two years already served under bail conditions since his 2018 arrest. His criminal prosecution has been deferred for one year under a deferred prosecution agreement, with charges to be dismissed if he fully complies with all terms. The case was initiated by the U.S. Attorney’s Office and HHS-OIG, with the civil complaint originally filed under the False Claims Act.

Enriched metadata

Scheme: health-care-fraud (100%)
Court: Southern District of New York
Outcome: charged
Settlement: $800,000

Classified health-care-fraud(confidence 100%). No EDGAR filing fingerprint (criminal/DOJ-side scheme). detection rule →

Extracted insights

Dollar amounts 4

$800K $800,000 $100K–$1M
$783K $783,200 $100K–$1M
$150K $150,000 $100K–$1M
$17K $16,800 $10K–$100K

Triples 12

Dr. Feng Qin agreed to pay $800,000
Dr. Feng Qin admitted Fraudulent Billing Of Medicare
Dr. Feng Qin received ban from Federal Healthcare Programs For Four Years
Qin Medical P.C. agreed to pay $783,200
Dr. Feng Qin was criminally charged with Fraudulently Billing Medicare For Medically Unnecessary Vascular Surgery Procedures
Dr. Feng Qin practiced in Lower Manhattan And Far Rockaway, Queens
Dr. Feng Qin previously paid $150,000 To Settle Prior Civil Fraud Lawsuit
Dr. Feng Qin entered into Voluntary Exclusion Agreement With HHS-OIG
Manhattan U.S. Attorney announced resolution of Civil And Criminal Healthcare Fraud Charges Against Dr. Feng Qin
Dr. Feng Qin performed procedures on End-Stage Renal Disease Patients
State Of New York expected to settle with Dr. Feng Qin For $16,800
Dr. Feng Qin entered into Deferred Prosecution Agreement For One Year

View original DOJ press releasejustice.gov

Extracted body text (7,073c)

Press Release Manhattan U.S. Attorney Announces Resolution Of Civil And Criminal Healthcare Fraud Charges Against Vascular Surgeon For Fraudulently Billing Medicare For Medically Unnecessary Procedures Monday, March 8, 2021 Share FacebookLinks to other government and non-government sites will typically appear with the “external link” icon to indicate that you are leaving the Department of Justice website when you click the link. XLinks to other government and non-government sites will typically appear with the “external link” icon to indicate that you are leaving the Department of Justice website when you click the link. LinkedInLinks to other government and non-government sites will typically appear with the “external link” icon to indicate that you are leaving the Department of Justice website when you click the link. Email For Immediate Release U.S. Attorney's Office, Southern District of New York Dr. Feng Qin Agrees to Pay $800,000, Admits Misconduct, and Receives Four-Year Ban from Participating in Federal Healthcare Programs Audrey Strauss, the United States Attorney for the Southern District of New York, and Scott Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s (“HHS-OIG”) New York Region, announced today that the civil and criminal healthcare fraud cases against FENG QIN, M.D. (“QIN”), a vascular surgeon, and his medical practice QIN MEDICAL P.C. (“QIN MEDICAL”) have been resolved. QIN, who practiced in Lower Manhattan and Far Rockaway, Queens, was criminally charged in December 2018 with fraudulently billing Medicare for vascular surgery procedures performed on end-stage renal disease (“ESRD”) patients that were not medically reasonable and necessary or covered under Medicare rules; the United States also filed a civil healthcare fraud complaint against QIN and QIN MEDICAL in December 2018. Under the civil settlement approved today by U.S. District Judge Laura Taylor Swain, QIN and QIN MEDICAL agreed to a pay $783,200 to the United States. The State of New York is expected soon to enter into an additional settlement with defendants in the amount of $16,800, for a total recovery of $800,000. The amount is based on the Office’s assessment of the defendants’ ability to pay based on the financial information they provided. As part of the settlement, QIN and QIN MEDICAL admitted and accepted responsibility for conduct alleged by the Government in its civil complaint as further described below. QIN previously paid $150,000 to settle a prior civil fraud lawsuit filed against him and his previous employer for engaging in fraudulent billing practices during the time period 2010 through 2012. QIN also entered into a Voluntary Exclusion Agreement with HHS-OIG, which prohibits him from participating in Medicare and other federal healthcare programs for four years. This is in addition to the more than two years he has been so excluded since his arrest, as a condition of his bail. The Government has agreed to defer QIN’s criminal prosecution for a period of one year, after which time it will seek to dismiss the charges if QIN abides by the terms of the deferred prosecution agreement. Manhattan U.S. Attorney Audrey Strauss said: “For several years, Dr. Qin performed interventional vascular procedures on patients with end-stage renal disease without any documented clinical justification. As a repeat offender, Dr. Qin now faces a lengthy suspension from participating in federal healthcare programs and must make a hefty monetary payment. This Office will continue to hold unscrupulous medical providers accountable when they perform and bill the Government for medically unnecessary procedures.” HHS-OIG Special Agent in Charge Scott Lampert said: “By billing Medicare for medically unnecessary procedures, Dr. Qin needlessly compromised patient care and victimized taxpayers. Our agency will continue to hold medical professionals accountable, while protecting the federal health care programs intended for those that depend on them for critical services.” According to the indictment and the Government’s civil complaint: Patients with ESRD who are receiving dialysis may require vascular access surgical procedures, such as fistulagrams, where dye is injected into the patient’s vein or artery to visualize blood flow, and percutaneous transluminal angioplasties, in which wires and balloons are inserted into blood vessels that have narrowed in order to restore blood flow. However, as Medicare billing guidelines made clear, it is not reasonable and necessary for physicians to bill the program for fistulagrams and angioplasties unless the patient has specific and documented clinical problems, such as significant difficulty receiving dialysis properly. The patients at QIN’s medical practice primarily consisted of ESRD patients undergoing dialysis treatment. During the relevant period, from 2015 to 2016, QIN routinely scheduled patients for fistulagrams and angioplasties three months in advance, and performed fistulagrams and angioplasties on these patients as a matter of routine, regardless of whether there was a justifiable clinical reason to do so. Furthermore, on multiple occasions he misrepresented the medical conditions of patients in their medical records to make it seem as if they suffered from symptoms that would warrant the procedures when they did not. QIN MEDICAL then unlawfully billed and received payment from Medicare for these procedures, which were excluded from Medicare coverage, as QIN knew. As part of the civil settlement, QIN and QIN MEDICAL admit, acknowledge, and accept responsibility for the following conduct: QIN often routinely scheduled, and actually saw, ESRD patients approximately every three months, regardless of their medical need. QIN treated many of his ESRD patients with fistulagrams and angioplasties. The symptoms documented in the medical records, including the records of the dialysis center and the treating nephrologist, were insufficient to justify these treatments for numerous ESRD patients. QIN knew that in the absence of a documented clinical justification, Medicare would not pay for fistulagrams or angioplasties. Nevertheless on numerous occasions, QIN MEDICAL sought and received reimbursement from Medicare for these treatments without the required documented clinical justification. The allegations of fraud stated in the civil complaint were first brought to the attention of federal law enforcement by a whistleblower who filed a lawsuit under the False Claims Act. The criminal case is being handled by the Office’s General Crimes Unit. Assistant United States Attorneys Jean-David Barnea, Michael Krouse, and Alexander Li are in charge of the criminal prosecution. The civil case is being handled by the Office’s Civil Frauds Unit, and Assistant United States Attorney Barnea is in charge of the matter. Contact James Margolin, Nicholas Biase (212) 637-2600 Updated March 8, 2021 Topic Healthcare Fraud Component USAO - New York, Southern Press Release Number: 21-047

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