Michigan vascular surgeon sentenced to 80 months in prison for medical fraud, agrees to pay up to $43,419,000 to settle false claims law case

Vasso Godiari, a Bay City, Michigan, vascular surgeon, was charged May 3 with orchestrating a multi-million dollar scheme to defraud health care programs by submitting claims for vascular stent placement and thrombectomy that he did not do. was sentenced to 80 months in prison. and ordered to pay $19.5 million in combined damages to Medicare, Medicaid, and the Blue Cross/Blue Shield of Michigan (BCBSM). In addition, Godiari agreed to pay the U.S. up to $43,419,000 to settle civil-related allegations that fraudulent claims to federal health care programs violated the False Claims Act (FCA).

According to a plea agreement Godiari signed on February 8, 2022, around 2009, Godiari began willfully defrauding health insurance companies, including Medicare and Medicaid. Godiari charged for placing multiple vascular stents in the same vessel and created medical records. It claims to document a medical need to justify its claim. But in reality, Mr. Godiari did not have these stents and charged for services that were never provided while creating substantially inaccurate medical records to justify fraudulent charges. admitted that

Godiari also claimed the cost of an arterial thrombectomy and created medical records stating that he encountered a blocked artery justifying the operation. However, he often does not encounter such blockages nor has he performed such thrombectomies, which were never provided while creating false medical records to justify fraudulent claims. He admitted that he billed the insurance company for the service. Godiari’s misconduct cost the federal government $14,473,000 in damages and Medicare, Medicaid, and BCBSM totaled $19.5 million in damages, which Godiari paid as part of a plea bargain. agreed to repay as

In a related FCA lawsuit, in addition to alleging that Godiari filed false claims for proceedings that he never performed, the United States also argued that Godiari improperly used the qualifier 59 to essentially group claims into one claim. It claimed it did so to “unbundle” services that should have been and increase the bill. Reimbursements from federal medical programs.

A civil forfeiture lawsuit resulted in the seizure of approximately $39.9 million from financial accounts controlled by Godiari. With the exception of $7.5 million, which will be released to Mr. Godiari’s wife pursuant to an agreement with the United States, all of the seized funds will be used to pay criminal judgments or FCA settlements.

Principal Deputy Assistant Attorney General Brian M. Boynton, Director of the Justice Department’s Civil Affairs Division, said, “We do not condone the use of federal health care programs as a source of personal enrichment.” “Today’s settlement demonstrates our commitment to protecting the integrity of these programs and the taxpayer funds used to support them.”

“My office’s priority is to protect our district from rogue health care providers,” said Dawn N. Ison, U.S. Attorney for the Eastern District of Michigan. “Dr. Godiari stole millions of dollars from public and private health insurance companies over the years and falsified medical records to hide his fraudulent schemes. , I also hope that other doctors will be stopped from trying to make their own money at the expense of the public.”

“This health care provider stole millions of dollars from taxpayers by charging federal health care programs for services that were neither medically necessary nor provided to patients.” said Mario M. Pinto, special officer for the Department of Health and Human Services’ Office of Inspectors. General (HHS-OIG). “As this litigation demonstrates, HHS-OIG and our partners are seeking to protect taxpayer material funds for purposes for which they were lawfully intended, and not for the illicit financial gain of private providers. We remain committed to ensuring that it is used for

“The scope of Mr. Godiari’s fraud is truly astonishing,” said Special Agent James A. Talaska of the FBI’s Detroit field office. “This study proves that law enforcement and private sector resources can be brought together successfully to combat fraud in the health care system.”

The Civil Settlement includes resolution of claims brought on the basis of: Kuitam or the Whistleblowing Provisions of the False Claims Act by Innovative Solutions Consulting, LLC. Under these provisions, private parties may sue on behalf of the United States and receive a portion of any recoveries. As part of the civil settlement, Innovative Solutions will receive up to $4,341,900.of Kuitam Case has caption US ex-rel. Innovative Solutions Consulting LLC v. Vasso Godziachvili Godiali, MDcase number 1:15-cv-14150-TLL-PTM (East Michigan).

The criminal case was filed by Assistant U.S. Attorneys John Neill, Philip Roth, and Craig Winninger of the Eastern District of Michigan. The FCA matter was handled by Senior Counsel Sarah Arni of the Department of Justice’s Civil Division and Assistant U.S. Attorney for the Eastern District of Michigan John Postolka. The civil forfeiture case was filed by Assistant U.S. Attorney Philip Roth for the Eastern District of Michigan. These matters were supported by HHS-OIG, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Inspector General’s Office.

Except for actions admitted in connection with criminal settlements, claims resolved in civil settlements are allegations only and no determination of liability.

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