The fraud was discovered by a medical office manager who filed a whistleblower lawsuit under the qui tam provisions of the False Claims Act.
A Georgia ophthalmologist has agreed to pay $1.85 million to settle allegations she violated the False Claims Act by fraudulently billing Medicare for medically unnecessary cataract surgeries and diagnostic tests as well as medical procedures she never performed.
The fraud was exposed by a former medical practice office manager who filed a whistleblower complaint under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of 15-30% of the settlement proceeds.
Medicare billings skyrocketed
According to the Justice Department, the ophthalmologist, Aarti D. Pandya defrauded Medicare by knowingly billing it for improper and non-existent medical procedures.
She allegedly diagnosed patients with and treated them for glaucoma when they had no signs or symptoms of the disease.
She also allegedly performed medically unnecessary cataract surgeries and falsely misclassified cataract surgeries as complex in order to charge Medicare more lucrative billing codes.
In some instances, the unnecessary procedures harmed patients, the Justice Department alleged.
The fraudulent billing scheme allegedly began when Dr. Pandya took over sole control of the ophthalmology practice in 2011, after which its charges to Medicare more than tripled, according to the Justice Department.
Fighting fraud on the taxpayer
The pursuit of civil litigation against parties who defraud federal healthcare programs is a top priority of the Justice Department. The False Claims Act is the government’s most powerful fraud-fighting litigation tool. It imposes significant liability on parties who knowingly defraud the federal government or its agencies.
Under the statute’s qui tam provisions, private parties known as relators or whistleblowers are authorized to sue violators on the government’s behalf and receive 15-30% of the proceeds as a whistleblower reward.
Talk to a whistleblower attorney
Fighting fraudulent overbilling of federal healthcare programs is a top priority of the Justice Department. If you have evidence of parties defrauding the federal government or its agencies, it is important to speak with an experienced False Claims Act lawyer about your legal rights as a potential False Claims Act whistleblower.
Simply reporting wrongdoing to a government agency or tip line will not entitle you to a whistleblower award. You must file a qui tam lawsuit.
Speak with healthcare whistleblower attorney Mark A. Strauss for a free consultation. All communications are protected by the attorney-client privilege and strictly confidential.