Defense Lawyers for Cardiologists Accused of Medicare Fraud Involving Sestamibi and Tetrofosmin

Our Lawyers Are Available to Represent Cardiologists Accused of Overbilling Novitas Solutions, Inc.

Two cardiologists in New Jersey have filed a massive qui tam lawsuit under the False Claims Act accusing more than a thousand other cardiologists of improperly billing Novitas Solutions, Inc. (“Novitas”) for sestamibi and tetrofosmin. The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services (HHS) are investigating these accusations; and, if proven, they could lead to civil or criminal charges exposing the targeted cardiologists to substantial penalties.

If you were named in the qui tam lawsuit–aimed at combating healthcare fraud involving sestamibi and tetrofosmin–or if you have been contacted by the DOJ, it is important that you engage experienced defense counsel promptly. The cardiologists who filed the lawsuit (who are referred to as “relators”) have lodged fraud allegations totaling more than $50 million Medicare reimbursements. This is an extremely serious matter, and the health care providers targeted in the lawsuit will need to defend themselves effectively to avoid unnecessary consequences.

What Are the Accusations?

The relators who filed the qui tam lawsuit allege Medicare billing fraud, claiming that cardiologists in Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania, Texas, Virginia and Washington D.C. have illegally overbilled Novitas for the radiopharmaceutical medications sestamibi and tetrofosmin. Specifically, they allege that while Novitas has stated that it will only reimburse for these drugs at cost, the targeted cardiologists have billed Novitas for these drugs at between $100 and $1,000 per dose—amounts that are supposedly “drastically more” than their acquisition costs.

Since Novitas provides these reimbursements through the Medicare program as a Medicare Administrative Contractor (MAC), the relators’ allegations fall under the False Claims Act. The False Claims Act prohibits healthcare providers from submitting “false or fraudulent” claims for reimbursement under Medicare and other government healthcare benefit programs.

What Are the Risks?

For the cardiologists targeted in the relators’ qui tam lawsuit, the risks involved have the potential to be substantial. The False Claims Act includes provisions for both civil and criminal enforcement. Potential penalties in civil and criminal enforcement cases include:

• Civil Penalties: Recoupments, treble (triple) damages, civil fines of up to $28,610 per claim (as of 2025), and loss of eligibility for federal healthcare programs.
• Criminal Penalties: Fines of up to $250,000 (for individuals) and five years of federal imprisonment.

At this stage, it isn’t yet clear whether the DOJ and its law enforcement partners will pursue criminal investigations or civil enforcement in these cases. However, our attorneys are monitoring the situation closely, and we can provide you with the latest information we have when you contact us for a consultation.

What Should You Do if You Have Been Named in the Qui Tam Lawsuit?

If you have been named in the qui tam lawsuit involving alleged fraud related to Novitas billings for sestamibi and tetrofosmin, what should you do? As we said above, it is important that you speak with a lawyer promptly. At Oberheiden P.C., we have extensive experience in healthcare law. We represent physicians and other clients in high-stakes healthcare fraud and Medicare fraud cases, and we can use our experience to help protect you by all means available.

Schedule a Complimentary and Confidential Consultation at Oberheiden P.C.

If you would like to speak with a Medicare fraud defense lawyer at our law firm, we encourage you to contact us promptly. To schedule a complimentary and confidential consultation with one of our senior lawyers as soon as possible, call us at 888-680-1745 or tell us how we can reach you online now.