Michigan vascular surgeon sentenced to 80 months in prison for healthcare fraud and agrees to pay up to $43.419 million to resolve False Claims Act allegations | takeover bid

Vasso Godiali, a vascular surgeon from Bay City, Michigan, was sentenced May 3 to 80 months in prison for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of stents and for thrombectomies he failed to have performed and was ordered to pay $19.5 million in collective restitution to Medicare, Medicaid and Blue Cross/Blue Shield of Michigan (BCBSM). Additionally, Godiali agreed to pay the United States up to $43,419,000 to resolve related civil allegations that its fraudulent billings to federal health care programs violated the False Claims Act (FCA).

According to a plea agreement Godiali entered into on February 8, 2022, Godiali began knowingly defrauding medical insurers, including Medicare and Medicaid, circa 2009. Godiali billed for the placement of multiple vascular stents in the same blood vessel and prepared medical records. claiming to document the medical necessity justifying this billing. In fact, however, Godiali did not place these stents and admitted to billing for services never performed while preparing materially inaccurate medical records to substantiate the fraudulent billings.

Godiali also billed for arterial thrombectomies and created medical records indicating he encountered occluded arteries that would warrant performing the procedures. However, he admitted that he often encountered none of these occlusions, performed none of these thrombectomies, and therefore billed insurers for services never rendered while preparing false medical records to substantiate the fraudulent claims. Godiali’s fraudulent practices resulted in damages of $14,473,000 to the federal government and a total of $19.5 million to Medicare, Medicaid and BCBSM, which he agreed to reimburse as restitution as part of of his plea agreement.

In the related FCA action, in addition to alleging that Godiali submitted false claims for procedures he never performed, the United States alleged that Godiali improperly used Modifier 59 to “unbundle” services that should have been billed together in one claim to increase its reimbursements from federal health care programs.

A civil forfeiture case resulted in the seizure of approximately $39.9 million from financial accounts controlled by Godiali. With the exception of $7.5 million, which will be given to Godiali’s wife under an agreement with the United States, all seized funds will be used to pay the criminal judgment or FCA settlement .

“We will not tolerate the use of federal health care programs as a source of personal enrichment,” said Senior Assistant Deputy Attorney General Brian M. Boynton, chief of the Justice Department’s Civil Division. “Today’s settlement demonstrates our commitment to protecting the integrity of these programs and the taxpayer funds used to support them.

“A priority of my office is to protect our district from unscrupulous health care providers.” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “Dr. Godiali stole an enormous amount of money from public and private health insurers over several years and falsified medical records to conceal his scheme of fraud. We hope that today’s conviction and significant recovery civilians will deter any other physicians equally inclined to line their pockets at the expense of the public.

“This provider stole millions of dollars from taxpayers by charging federal health care programs for services that were neither medically necessary nor rendered to its patients,” said Special Agent in Charge Mario M. Pinto of the office. of the inspector of the Ministry of Health and Social Services. General (HHS-OIG). “As this case demonstrates, HHS-OIG and our partners remain committed to ensuring that vital taxpayer dollars are used lawfully and for their intended purpose, and not for the improper financial gain of an individual vendor.”

“The scale of Godiali’s fraud is truly staggering,” said Special Agent in Charge James A. Tarasca of the FBI’s Detroit field office. “This investigation proves that the collective resources of law enforcement and the private sector can successfully combat fraud in our healthcare system.”

The civil settlement includes the resolution of claims filed under the qui tam or whistleblower provisions of the False Claims Act by Innovative Solutions Consulting, LLC. Under these provisions, a private party can sue on behalf of the United States and receive a portion of any recovery. As part of the civil resolution, Innovative Solutions will receive up to $4,341,900. The qui tam case is subtitled US ex rel. Innovative Solutions Consulting LLC v Vasso Godziachvili Godiali, MD, Case No. 1:15-cv-14150-TLL-PTM (ED Mich.).

The criminal case was prosecuted by Assistant United States Attorneys John Neal, Philip Ross and Craig Wininger for the Eastern District of Michigan. The FCA case was handled by Lead Counsel Sarah Arni of the Justice Department’s Civil Division and Assistant U.S. Attorney John Postulka for the Eastern District of Michigan. The civil forfeiture action was handled by Assistant U.S. Attorney Philip Ross for the Eastern District of Michigan. These matters have received assistance from HHS-OIG, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Inspector General’s Office.

Except with respect to conduct admitted under the criminal resolution, the claims resolved by the civil settlement are allegations only and there has been no determination of liability.

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