AV Care and Qin Medical: Surgery on a Three-Month Schedule

The AV Care vascular procedure settlements began with a $1,150,000 agreement over surgery the practice performed only for surveillance and billed to Medicare. The same surgeon later faced another civil settlement at Qin Medical. Both matters concerned dialysis patients returning for invasive procedures. Qin Medical admitted billing Medicare without the documented clinical justification it required. For someone inside a vascular practice or dialysis center, the central question is familiar: did the patient’s condition drive the next procedure, or did the calendar?

AV Care ran vascular surgery offices in Manhattan and Queens. The surgeon later practiced at Qin Medical in Lower Manhattan and Far Rockaway, Queens.

What Fistulagrams and Angioplasties Were Supposed to Treat

A fistulagram uses injected dye to visualize a dialysis patient’s access site and the nearby vessels. An angioplasty uses wires and balloons inside a narrowed vein or artery to restore blood flow.

Routine monitoring already had its place in the patient’s care. The Justice Department described nephrologists, dialysis nurses and technicians as the people who typically monitored the access site, with Medicare paying for that ongoing work. AV Care’s case concerned additional vascular procedures billed as though the patient’s condition justified them.

Under the New York Medicare rules described in the AV Care case, payment for these procedures required a specific clinical problem, such as significant difficulty receiving dialysis properly. An angioplasty also required evidence of a restriction greater than 50% of the vessel’s diameter, alongside the clinical findings supporting a fistulagram.

How a Standing Schedule Became a Medicare Claim

The government alleged that AV Care routinely scheduled fistulagrams and angioplasties as many as three months ahead, then performed fistulagrams even when patients arrived without a clinical reason for them. The complaint described conduct from December 2010 through April 2012.

The allegation followed the patient through the office. An appointment put the procedure on the calendar. The patient’s condition at the visit was supposed to justify going ahead. Yet the government said the practice’s surgeons, this surgeon among them, performed fistulagrams as a matter of routine, and he sometimes performed angioplasties without records supporting the required degree of narrowing. The practice then billed Medicare for the procedures.

That is the connection an insider can see: the standing appointment, what the patient actually needed, the intervention performed and the bill. The calendar supplied a reason to return. The government said the clinical record did not supply a reason to operate.

The First AV Care Settlement Included Admissions

In the settlement announced on May 6, 2015, the practice and the surgeon admitted that they regularly performed vascular surgery procedures only for surveillance and billed Medicare in violation of its billing rules.

Of that first settlement, the practice agreed to pay $1 million and the surgeon separately agreed to pay $150,000. Both entered integrity agreements with the Department of Health and Human Services’ Office of Inspector General, agreeing to compliance measures and monitoring.

The surgeon had already agreed to compliance measures at AV Care. The next case again concerned patients returning on a standing schedule, this time at Qin Medical.

Qin Medical’s Later Settlement Returned to the Same Schedule

Qin Medical and the surgeon agreed to pay $783,200 to the United States under the civil settlement announced on March 8, 2021. The Justice Department’s announcement said New York was expected to enter an additional $16,800 settlement. The amount reflected the government’s assessment of the defendants’ ability to pay.

According to the Justice Department’s announcement, the criminal indictment charged that, during 2015 and 2016, the surgeon scheduled procedures three months ahead and performed them routinely, regardless of a justifiable clinical reason. It also charged that he misrepresented patients’ conditions in their medical records to make symptoms appear sufficient for the procedures, and that Qin Medical billed Medicare and received payment. The government’s civil complaint alleged the same conduct.

The civil settlement contained specific admissions. The surgeon and Qin Medical accepted responsibility for routinely seeing patients approximately every three months regardless of medical need. They admitted that symptoms documented in medical records, including those from dialysis centers and treating nephrologists, were insufficient to justify numerous patients’ treatments.

They also admitted that the surgeon knew Medicare would not pay without documented clinical justification, yet Qin Medical sought and received reimbursement without it. Qin Medical billed Medicare for invasive procedures on dialysis patients without the documented clinical justification Medicare required, and was paid.

What Evidence Is Needed to Prove Fraud?

For this kind of vascular procedure case, the evidence connects the appointment schedule, the patient’s clinical condition, the treatment and the Medicare claim. The Qin Medical admissions make the comparison unusually concrete: the records of the dialysis center and treating nephrologist did not document symptoms sufficient to justify the procedures.

Those records matter because the vascular office’s account can be compared with the ongoing dialysis care. We examine how the reason recorded for an intervention fits what the care team documented, what the procedure notes show and what the practice billed. The question is what supported the procedure for that patient at that visit.

A dialysis employee may know what symptoms the patient reported. A scheduler may know whether repeat procedures were booked routinely. A clinician or billing employee may understand how the treatment and its justification reached the claim. We work with the part you know and connect it to the rest of the case.

Medical Necessity Follows the Procedure Into the Bill

Medicare’s coverage law requires the care to be reasonable and necessary.

The same connection appears in the government’s case involving EMH Regional Medical Center and North Ohio Heart Center. The government alleged unnecessary angioplasty and stent placement in patients whose vessels were not sufficiently blocked to require those procedures. Those providers settled the allegations. AV Care and Qin Medical made the specific admissions described above.

A Whistleblower Brought the Later Billing Allegations Forward

The Justice Department said a whistleblower’s False Claims Act lawsuit first brought the Qin Medical allegations to federal law enforcement. The health care billing case reached into decisions made inside the practice: recurring visits, the symptoms documented and reimbursement sought despite the physician’s knowledge of Medicare’s requirements.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Why the Patient Came Back

If you saw repeat vascular procedures go ahead without the clinical need the bills claimed, speak with our whistleblower experts. We build the case with you around the scheduling, patient records and Medicare payments, bring in healthcare fraud whistleblower lawyers who understand medical necessity cases, and stay beside you through the pursuit of a recovery.