DOJ Settles Civil Medical Necessity Claims With Health System While Orthopedic Surgeon Remains A Fugitive From Criminal Charges

By: James W. Kraus

On Friday, the DOJ announced it had reached an agreement with an Ohio health system to settle allegations of violations of the False Claims Act for costs resulting from medically unnecessary procedures performed at one of the system’s hospitals.  Under the agreement, Cincinnati-based West Chester Hospital and its parent company, UC Health, will pay $4.1 million to settle claims that West Chester billed the government for medically unnecessary procedures performed by orthopedic surgeon Abubakar Atiq Durrani, M.D

According to the government, the false claims consisted of hospital charges for spine surgeries performed by Dr. Durrani between 2009 and 2013.   At the time of the announcement of the settlement, Principal Deputy Assistant AG Benjamin C. Mizer distinguished the responsibility of the hospital from that of the surgeon, saying that “hospitals have the responsibility to ensure that services provided at their facilities are medically necessary and appropriate before they bill federal healthcare programs for those services.”

The government has charged Dr. Durrani criminally, alleging that he intentionally made false claims and false statements in relation to cervical, thoracic and lumbar surgeries.  After being arraigned on those criminal charges in 2013, Dr. Durrani reportedly fled to his native Pakistan, and remains a fugitive.  The pending criminal charges include several sensational allegations of bogus surgical recommendations made by Dr. Durrani to patients.  This included allegations that Dr. Durrani falsely informed patients that their conditions were surgical emergencies when they were not, and going further in some instances by telling patients they were at risk for paralysis or that a patient’s head would fall off if the patient were in a car accident because there was nearly nothing holding it on.

Dr. Durrani is also the subject of more than 250 civil malpractice claims by former patients, including one that went to trial shortly after Durrani fled the country and resulted in a judgment in the amount of $750,000.  Another such case went to trial in 2014 and actually resulted in a verdict in his favor.  The hospital has denied allegations by many of the plaintiffs that it was at fault for failing to scrutinize Dr. Durrani’s credentials, which some plaintiffs allege were falsified.

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