A well-known Ashland heart doctor has been convicted of fraud in a case in which he was accused of performing needless procedures to get payments from Medicare, Medicaid and private insurers.
A jury convicted Richard E. Paulus on Thursday.
Paulus was convicted of placing stents in patients whose heart conditions did not justify the procedures and of performing unnecessary diagnostic heart catheterizations, U.S Attorney Kerry B. Harvey said in a news release.
An indictment charged that Paulus submitted claims for hundreds of medically unnecessary heart procedures during a five-year period from 2008 to 2013, but not all those cases were covered in the charges.
Evidence at the trial showed Paulus placed stents in more than 70 patients with heart blockages that were not serious enough to warrant the procedure, then recorded false information to get paid, according to the release from Harvey.
From 2006 to 2012, Paulus billed Medicare for the most heart procedures of any cardiologist in Kentucky and was among the top billers in the nation, the news release said.
“All of us rely on our health care providers to make treatment decisions based solely on medical considerations, untainted by financial considerations,” Harvey said. “The jury determined that Dr. Paulus dishonored this fundamental duty to many of his patients in order to defraud federal health care programs.”
Paulus, who is in his late 60s, is scheduled to be sentenced in April. The most serious charge against him has a top sentence of 20 years.
Attorneys for Paulus have asked U.S. District Judge David L. Bunning to acquit Paulus, arguing that at most, the evidence showed only honest mistakes or disagreements among cardiologists.
The heart procedures Paulus did were legitimate, his attorneys argued.
If Bunning denies the request, Paulus will appeal, said Robert S. Bennett, one of his attorneys.
“As Winston Churchhill said, ‘We have just begun to fight,’” Bennett said.
Paulus was licensed in Kentucky in 1992. He sold his practice to King’s Daughters Medical Center in 2008 and then worked under an agreement with the hospital to do heart procedures, the indictment said.
Court documents said that from 2006 to 2012, King’s Daughters received more than $30 million for surgeries performed by Paulus, and in turn paid him $10 million from 2010 through 2013.
Paulus retired in 2013 and was indicted last year.
In a separate federal case, King’s Daughters agreed in May 2014 to pay the government $40.9 million to settle claims that it knew Paulus and other doctors were performing surgeries that were not medically justified.
The hospital did not admit wrongdoing, but agreed to internal reforms and to increased monitoring of its claims to federal health care programs.
There have been several federal complaints in Kentucky in recent years alleging multimillion-dollar health care fraud.
In one case, St. Joseph Health System agreed in 2014 to pay $16.5 million to settle accusations that doctors at its hospital in London performed hundreds of unnecessary heart surgeries to pad the bottom line.
One doctor, Sandesh R. Patil, pleaded guilty in connection with the fraud and was sentenced to two years and six months in prison. Another, Anis Chalhoub, faces trial in January.
In another case, the operators of an addiction-recovery business and a drug-testing lab agreed in February 2014 to pay $15.7 million to resolve allegations that they took part in fraud involving billing for urine tests.
Physicians Robin Peavler, Bryan S. Wood and Robert L. Bertram Jr., along with former Russell Springs Mayor Brian C. Walters and businessman James W. “Wes” Bottom, are fighting federal charges that arose from the alleged improper billing.