Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs
This week’s Department of Justice (DOJ) “Catch of the Week” goes to Michigan vascular surgeon Vasso Godiali. Yesterday, DOJ announced he was sentenced to 80 months in prison “for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform.”
In addition to the jail time, Dr. Godiali also has to pay $19.5 million in restitution to Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. And he agreed to pay another $43.4 million to settle related civil charges that his fraudulent government billings violated the False Claims Act.
Almost seven years in jail and a payout of more than $60 million is quite the punishment for fraud. Here is why the government came down so hard. First, Dr. Godiali for the past fifteen years billed the government health care programs for the placement of multiple vascular stents he never actually placed. And he backed it all up with falsified medical records purporting to document the medical necessity of the procedures he never actually performed.
Second, he likewise billed for arterial thrombectomies he never performed, also backed up with falsified medical records reflecting the presence of occluded (blocked) arteries that would justify the performance of the procedures. However, “he admitted that he often encountered no such occlusions, performed no such thrombectomies, and thus billed insurers for services never rendered while preparing false medical records to justify the fraudulent claims.”
In its press release announcing the sentencing, the government made it clear how offended it was by Dr. Godiali’s misconduct, calling it “egregious” and “truly stunning” in its scope. The government also stressed “it will not tolerate this kind of healthcare fraud,” and hoped its action against Dr. Godiali will “deter any other physicians likewise inclined to line their pockets at the expense of the public.”
The proceeding against Dr. Godiali is just the latest in a string of government enforcement actions against vascular physicians for fraud. As reported earlier this week in ProPublica, this area of healthcare has become a hotbed of fraud, “making doctors rich and putting patients in danger.” All the more reason for the government slapping Dr. Godiali down so hard. Also a good reason to be extra vigilant in this area of medical care.
As compliance professionals, potential patients, and ultimately whistleblowers who are best positioned to uncover these kinds of unscrupulous practices, we should all be on guard. Notably, it was a whistleblower — presumably someone who worked with Dr. Godiali — who uncovered his extreme misbehavior. This individual brought it to the government’s attention by filing a qui tam lawsuit under the False Claims Act, which allows individuals to bring lawsuits on behalf of the government alleging fraud on the government.
Often, like here, that fraud is from improper or inflated billings to Medicare or Medicaid. In return, the whistleblower is entitled to anywhere from 15 to 30 percent of any government recovery. In this case, the whistleblower award amounted to $4.3 million, representing a healthy chunk of the portion of Dr. Godiali’s payout under the False Claims Act. But more than the money this whistleblower received, he or she stopped a long-lasting scheme that not only stole millions from the government coffers, but also needlessly put numerous patients in harm’s way.
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