By Steve Schuster
Vasso Godiali, a vascular surgeon from Bay City, Michigan, was sentenced last month 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, according to Justice Department officials.
Godiali was ordered to pay $19.5 million in restitution collectively 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 his fraudulent billings to federal health care programs violated the False Claims Act (FCA), officials added.
According to a plea agreement, Godiali began to knowingly defraud medical insurers, including Medicare and Medicaid, in approximately 2009. Godiali billed for the placement of multiple vascular stents in the same blood vessel and prepared medical records purporting to document the medical necessity justifying that billing. In fact, however, Godiali did not place those stents and admitted to billing for services never rendered while preparing materially inaccurate medical records to justify the fraudulent billings, officials noted.
Godiali also billed for arterial thrombectomies and created medical records that stated he encountered occluded 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. Godiali’s fraudulent practices resulted in $14,473,000 in damages to the federal government, and a total of $19.5 million across Medicare, Medicaid, and BCBSM, which he agreed to repay as restitution as part of his plea agreement.
In the related FCA action, in addition to alleging that Godiali submitted false claims for procedures that he never performed, the United States alleged that Godiali improperly used Modifier 59 to “unbundle” services that should have been billed together in a single claim to increase his reimbursements from federal health care programs.
A civil forfeiture case resulted in the seizure of nearly $40 million from financial accounts controlled by Godiali. Except for $7.5 million, which will be released to Godiali’s wife pursuant to an agreement with the United States, all of the seized funds will be used to pay the criminal judgment or the FCA settlement.
“We will not tolerate the use of federal health care programs as a source of personal enrichment,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement demonstrates our commitment to protecting the integrity of those programs and the taxpayer funds used to support them.”
“A priority of my office is protecting our district against 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 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,” he added.
“This provider egregiously stole millions of dollars from taxpayers by billing federal health care programs for services that were neither medically necessary nor rendered to his patients,” said Special Agent in Charge Mario M. Pinto of the Department of Health and Human Services Office of Inspector 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 purposes, not for the illegitimate financial gain of an individual provider,” he added.
“The scope of Godiali’s fraud is truly stunning,” said Special Agent in Charge James A. Tarasca of the FBI Detroit Field Office.
“This investigation proves the collective resources of law enforcement and the private sector can successfully combat fraud in our health care system,” SAC Tarasca added.
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Innovative Solutions Consulting, LLC. Under those provisions, a private party can file an action 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 captioned U.S. ex rel. Innovative Solutions Consulting LLC v. Vasso Godziachvili Godiali, M.D., Case No. 1:15-cv-14150-TLL-PTM (E.D. Mich.), Justice Department Officials said.
The criminal case was prosecuted by Assistant U.S. Attorneys John Neal, Philip Ross, and Craig Wininger for the Eastern District of Michigan. The FCA matter was handled by Senior Trial 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 received assistance from HHS-OIG, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Office of Inspector General.
Click Here to view a copy of the settlement agreement obtained by the Wisconsin Law Journal.
Officials noted that except as to conduct admitted in connection with the criminal resolution, the claims resolved by the civil settlement are allegations only and there has been no determination of liability.