United States ex rel. Zverev v. USA Vein Clinics of Chicago, LLC

244 F. Supp. 3d 737, 2017 U.S. Dist. LEXIS 43807
CourtDistrict Court, N.D. Illinois
DecidedMarch 27, 2017
DocketNo. 12 CV 8004
StatusPublished
Cited by7 cases

This text of 244 F. Supp. 3d 737 (United States ex rel. Zverev v. USA Vein Clinics of Chicago, LLC) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States ex rel. Zverev v. USA Vein Clinics of Chicago, LLC, 244 F. Supp. 3d 737, 2017 U.S. Dist. LEXIS 43807 (N.D. Ill. 2017).

Opinion

MEMORANDUM OPINION AND ORDER

John J. Tharp, Jr., United States District Judge

Plaintiff-Relator Constantine Zverev brings this qui tam action on behalf of the United States of America and the states of Illinois, California, Massachusetts, and New York under the federal False Claims Act, 31 U.S.C. § 3729(a)(1)(A)-(C), Illinois False Claims Act, 740 Ill. Comp. Stat. 175/1 et seq., California False Claims Act, Cal. Gov’t Code § 12650, et seq., Massachusetts False Claims Act, Mass. Gen. Laws ch. 12 §§ 5A-50, New York False Claims Act, N.Y. State Fin. Law, §§ 187-194, and the Illinois Insurance Claims Fraud Prevention Act, 740 Ill. Comp. Stat. 92/1 et seq. The crux of Zverev’s allegations is that the defendants, his former employers, schemed to defraud Medicare and Medicaid (as well as various other private insurance providers) by billing those providers for medical procedures that were either never performed, performed inadequately, or performed when medically unnecessary. Zverev also maintains that once it was discovered that he was conducting his own private investigation of these acts, h'is employment was terminated him in retaliation, and in violation of the Federal False Claims Act, 31 U.S.C. § 3730(h)(1) and the Illinois Whistleblower Act, 740 Ill. Comp. Stat. 174/20. The defendants move to dismiss Zverev’s Second Amended Complaint (“complaint”) in its entirety. For the reasons that follow, that motion is granted in part and denied in part.

BACKGROUND

In addition to Dr. Yan' Katsnelson, a cardiovascular surgeon, the complaint names numerous limited liability corporations as defendants in -the action. According to the complaint, defendant Dr. Katsnelson either owns or controls the defendant entities in them entirety,' and they operate in an integrated and uniform manner in terms of “policies, practices, treatment and billing modalities.” Sec. Am. Compl. (“Compl.”), ¶13, ECF No. 37. Each of the corporate defendants is centrally connected to a common computer system and common databases. For 'simplicity’s sake, the corporate defendants will generally be referred to [741]*741collectively as “USA Vein” except where noted.

USA Vein provides in-patient endovas-cular laser therapy (“EVLT”) procedures. EVLT is used to treat varicose veins, which are veins that are visibly swollen and twisted. The EVLT procedure entails the insertion of a heated laser fiber into the target vein via a catheter. The physician then gradually increases the fiber’s temperature until reaching the required temperature. The fiber is then removed, which collapses the vein and shut off circulation through it. The vein then slowly dies off, and blood is diverted through the remaining healthy veins. EVLT can serve both cosmetic and medical purposes; the defendants obtained reimbursement for medically necessary EVLT procedures rendered to patients insured through Medicare, Medicaid, and private insurance plans.

Plaintiff-Relator Constantine Zverev worked out of USA Vein’s Northbrook, Illinois clinic as an information technology and data analyst from May 2011 through October 2011. As an analyst, he was responsible for compiling patient data and creating programs that could be used to identify trends in patient populations and the services they requested. In conducting these duties, he claims to have had access to USA Vein’s patient data including patient identifying information, dates of service, and details of services provided. The complaint also refers to “billing data spreadsheets” to which Zverev claims he had access {e.g,, Compl. ¶ 100).

In reviewing this information, Zverev became suspicious of the defendants’ billing practices. He first became concerned when he was copied on an email sent from Cathy Mata, USA Vein’s billing manager, to Dr. Katsnelson, Jekaterina Rapaport (USA Vein’s insurance manager for Illinois), and Stella Gazaryan (USA Vein’s office manager for California). The email stated “I noticed that Dr. Katsnelson is billing in Boston and Chicago in the same date. We should be more careful.” Id. at ¶87. His interest piqued, Zverev began sleuthing through USA Vein “patient databases” {id. at ¶ 88) looking for examples of such occurrences. These databases included a patient database and a billing database; the latter, according to the complaint, indicated which insurer was billed for which patient.

According to Zverev, this review revealed that the defendants were billing Medicare for EVLT procedures that could not have possibly been completed on the dates that the defendants represented in the bills. He points, for example, to records indicating that on October 12, 2009 Dr. Katnelson performed eight EVLT procedures on eight different patients in Chicago, while on’ the same day he also apparently conducted five initial patient visits in Boston. At least six of these patients were billed for the defendants’ services through Medicare. These same records allegedly indicate that on March 22, 2010—in a single day—Katsnelson performed nineteen patient visits in Chicago, eight in New York, and fourteen in Boston. Zverev maintains that at least thirty-one of these forty patients were insured through Medicare or Medicaid, and that Medicare or Medicaid was subsequently billed for those procedures. Similarly, records indicate that on March 23, 2010 Dr. Katsnelson billed for nine patient visits in Chicago, two in New York, and twenty in Boston. At least twenty-six of these thirty-one patients were billed through Medicare or Medicaid. Assuming an hour per procedure, Zverev concluded that the defendants were billing more procedures than Katsnelson possibly could have completed and so must have been engaged in a scheme to defraud insurance providers, including Medicare and Medicaid, by billing for services that were never rendered. Zverev’s suspicions were [742]*742further bolstered by a conversation that Zverev allegedly had with another one the defendants’ employees, Dr. Melkonyan. Melkonyan told. Zverev that he had been asked by Dr. Katnelson to sign off on several altered and backdated patient bills, which reflected charges for services which he .(Melkonyan) had never actually performed. Shortly after this conversation, Dr. Melkonyan left his job with USA Vein.

In addition, Zverev maintains that the defendants also billed insurance providers for “services inadequately rendered.” Id, ¶¶ 82, 110, 113-116. More specifically, Zverev alleges that Katsnelson and other doctors at USA Vein reused what were supposed to be single use laser fibers when performing EVLT procedures, while billing Medicare and Medicaid for new fibers in connection with each procedure. The complaint alleges that several doctors and technicians who worked,.or formerly worked, at several USA Vein locations told Zverev that Dr. Katsnelson directed them to sterilize and reuse single-use fibers, and that Zverev had personally observed fibers soaking in a sterilization fluid even though they were only supposed to be used once. He claimed that the defendants then “billed Medicare, Medicaid and private insurers, as if the procedure were properly-conducted using new instruments.”' Id. at ¶ 84.

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Bluebook (online)
244 F. Supp. 3d 737, 2017 U.S. Dist. LEXIS 43807, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-zverev-v-usa-vein-clinics-of-chicago-llc-ilnd-2017.