COURT HOUSE — A whistle-blower has accused a local doctor of submitting false claims to Medicare and a federal judge has found the charges legitimate and will let a jury decide if the doctor’s claims were knowingly fraudulent.
Dr. Christopher Lucasti, an infectious disease specialist who has worked with Cape Regional Medical Center, Shore Memorial Hospital and AtlantiCare Regional Medical Center, was charged in March 2006 by a former employee, Silvana Landau, with incorrectly billing Medicare over several years for procedures.
“As a result of these violations, the United States has paid approximately $7 million to Lucasti, which he was not entitled to receive,” according to Landau’s original complaint.
Landau, of Petersburg, who worked in Lucasti’s Somers Point office (South Jersey Infectious Disease) from 1998 to 2005, alleges that Lucasti charged Medicare for outpatient intravenous antibiotic treatments to patients as if he completed or supervised the procedures himself, when it was actually nurses in his office who performed the treatments. Lucasti admitted that he was not present in the office at the time of the treatments.
Landau said Lucasti did this hundreds of times over the years that she worked for him. She said the doctor knew this practice went against Medicare billing rules because she informed him of the problem on several occasions.
Lucasti testified that he believed the Medicare regulations only required him to be “simply available, either in the office suite or via telephone or where I’m available to my nurses.”
Witnesses for the defense had similar views.
“The standard practice in the medical industry does not require a physician to always be present in the office suite at all times during OPAT [infusion treatment], as long as he is available by telephone and there are medical professionals in the office monitoring the OPAT,” said infectious disease specialist Dr. Alan Tice.
Dr. Philip Paparone, another defense witness, confirms that Lucasti’s infusion practice meets “the standard of practice executed by multiple practitioners who engage in outpatient antibiotic therapy services to Medicare patients” in southern New Jersey.
However, according to current regulations effective Jan. 1, 2002, medical services must be performed under the direct supervision of the physician in order to be covered by Medicare. The rules state that “direct supervision” means the physician must be “present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.”
It is not clear whether Lucasti’s nurses were qualified non-physician practitioners, but assuming they were, Medicare reimbursement should only be sought at a lower rate for such practitioners, no more than 85 percent of the physician fee schedule amount for the service, according to the regulations.
In an opinion entered on Jan. 6 this year, U.S. District Court Judge Jerome B. Simandle found that Lucasti’s Medicare claims for services done when he was not present after Jan. 1, 2002 were false claims. He dismissed the claims prior to that date because the Medicare rules were less clear at that time.
In addition, the judge denied a summary judgment against Lucasti noting that a jury must decide if the doctor knew that his actions were wrong.
“It remains for the plaintiff (Landau) to prove at trial that defendants (Lucasti) caused such claims for infusion therapy incident to physician’s services to be submitted to Medicare after January 1, 2002, and that defendants knew these claims were false or fraudulent, meaning either actual knowledge of falseness, deliberate ignorance of the truth or falsity of the claim, or reckless disregard of the truth or falsity of the claim, and to prove for each such claim the amount of damages sustained by Medicare,” the opinion stated.
If the jury finds Lucasti liable, Landau could reap a large financial benefit.
In addition to the huge amount of alleged damages, Landau’s attorney Joseph Martin, of Haddonfield, said Lucasti could be charged penalties of between $5,000 and $11,000 for each of the hundreds of false Medicare claims. That figure would be tripled, Martin said.
As the whistle-blower, Landau would be eligible to receive between 25 and 30 percent of the penalties.
According to Herald archives, Landau was charged in 2005 with stealing some $17,632 in state grant funds from Access One, a nonprofit AIDS clinic in Lucasti’s office. Landau’s difficulties started in May of that year when she was fired after allegedly ordering a fraudulent prescription for former state Sen. Nicholas Asselta to treat his poison ivy. Her replacement at Access One turned up the alleged theft.
Contact Hart at (609) 886-8600 Ext 35 or at: jhart@cmcherald.com
