Medicare Compliance & Reimbursement

The feds continue to levy significant convictions and penalties against fraudsters — and the numbers keep getting bigger.

Lowdown: In another major False Claims Act (FCA) case, Bay City, Michigan vascular surgeon Vasso Godiali was sentenced to more than 80 months in prison for a years-long scheme to defraud Medicare, Medicaid, and private payer Blue Cross/ Blue Shield of Michigan. Starting in 2009, the physician began submitting false claims for “the placement of vascular stents and for thrombectomies that he did not perform,” a Department of Justice (DOJ) release indicates.

On top of billing for the thrombectomies and vascular stents he neither performed or placed, Godiali also created sham medical records to bolster his claims and used the system to unbundle procedure to take home more money. “The United States alleged that Godiali improperly used modifier 59 [Distinct procedural service] to ‘unbundle’ services that should have been billed together in a single claim to increase his reimbursements from federal health care programs,” the DOJ notes.

In addition to his prison sentence, Godiali was ordered to pay $19.5 million in restitution to the insurers he defrauded and has agreed to pay $43.419 million for the civil allegations under the FCA.

“Dr. Godiali stole an enormous amount of money from both public and private health insurers over a number of years, and falsified medical records to cover up his scheme to defraud. We hope that today’s sentence and substantial civil recovery deter any other physicians likewise inclined to line their pockets at the expense of the public,” cautioned U.S. Attorney Dawn N. Ison for the Eastern District of Michigan in the DOJ release.

Review the case specifics at www.justice.gov/opa/pr/michigan-vascular-surgeon-sentenced-80-months-prison-health-care-fraud-conviction-and-agrees.