Whistleblowers Help Government Uncover “Stunning” Scope of Healthcare Fraud

healthcare fraud

On May 25th the Department of Justice announced that Vasso Godiali, a vascular surgeon from Bay City, Michigan, agreed to pay the United States up to $43 million to resolve allegations that he violated the False Claims Act (FCA). The agreement between him and the government described alleged fraudulent billings to Medicare and Medicaid.

Before the civil settlement was reached, Godiali reached a plea agreement on criminal healthcare fraud charges sentencing him to 80 months in prison for orchestrating a multimillion-dollar scheme to defraud health care programs. According to the settlement agreement, Godiali acknowledges that beginning in 2009 he caused his employees to bill Medicare and Medicaid for placing multiple stents in the same vessel for the same patient, in effect charging the federal healthcare programs for operations he did not perform. He also submitted payments for thrombectomies (removals of blood clots) that were never performed. $14.5 million of the total $43 million settlement is set aside for restitution to the government. A civil forfeiture case resulted in the seizure of approximately $39.9 million from financial accounts controlled by Godiali.

“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.”

The alleged FCA violations were uncovered by Innovative Solutions Consulting, LLC who blew the whistle on Godiali through the qui tam provision of the FCA. Qui tam claims 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. Innovative Solutions Consulting will receive up to $4,341,900 depending on the final amount recovered from Godiali. The over $4 million “relator’s share” was derived from being 25 perfect of a $17,367,600 portion of the overall settlement.

Special Agent in Charge James A. Tarasca of the FBI Detroit Field Office said that “the scope of Godiali’s fraud is truly stunning.” He added that “this investigation proves the collective resources of law enforcement and the private sector can successfully combat fraud in our health care system.”

“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.”

“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.”

Further Reading:

Michigan Vascular Surgeon Sentenced to 80 Months in Prison for Health Care Fraud Conviction and Agrees to Pay Up to $43.419 Million to Resolve False Claims Act Allegations

More False Claims Act Whistleblower News

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