A gynecologic oncologist, will pay $775,000 to resolve allegations that he violated the False Claims Act. The settlement resolves allegations brought forth in a qui tam, or whistleblower, lawsuit filed by three whistleblowers, who will receive a combined portion of the settlement amount.
According to the U.S. Department of Justice (DOJ) press release, the government alleged that “from February 1, 2011, through June 30, 2017, “Dr. Malviya knowingly submitted false claims for payment to federal health care programs.” The false claims were related to “(1) radical hysterectomies and modified radical hysterectomies that Dr. Malviya performed when only simple hysterectomies were medically necessary; (2) chemotherapy services that Dr. Malviya administered or ordered that were in excess of what was medically necessary; and (3) evaluation and management services by Dr. Malviya that were not performed or not rendered as represented.”
The press release reports that this settlement is connected to a $2.8 million settlement that occurred in August of 2021 in which Ascension Michigan, a hospital group comprised of four hospitals, settled allegations of submitting false claims. At the time, a gynecologic oncologist was not named and just referenced as “the Doctor.” Whistleblowers Pamela Satchwell, Dawn Kasdorf, and Bethany Silva-Gomez received a combined $532,000 from the Ascension Michigan settlement.
The qui tam provisions of the False Claims Act enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery, if one occurs. In the April 2022 settlement involving Dr. Malviya, the three whistleblowers “will receive a combined payment” of $147,250.
In addition to paying $775,000 as part of the settlement, Dr. Malviya has “agreed to be excluded from Medicare, Medicaid and all other federal health care programs for a period of three years.” This means that over this period, “federal health care programs will not pay anyone for items or services, including administrative and management services, furnished, ordered or prescribed by Dr. Malviya in any capacity.”
Whistleblowers are key to uncovering fraud and corruption in the healthcare industry: fraudulent schemes can be particularly harmful to patients and erode trust in the medical system. In Fiscal Year 2021, whistleblowers helped the DOJ recover $1.6 billion in settlements. The DOJ highlighted health care fraud as “the leading source of the department’s False Claims Act settlements and judgments.”
“Every day, patients rely on their doctors’ medical judgment to determine what type of medical care is reasonable and necessary,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, in the press release. “We will continue to pursue doctors who knowingly abuse this trust and subject their patients to unnecessary treatments or procedures.”
