19 January 2023. The United States Department of Justice settled a case against a Conyers, Georgia-based physician and medical practice for False Claims Act violations. Under the terms of the settlement, Aarti D. Pandya, M.D. and Aarti D. Pandya, M.D.P.C. (“Pandya Practice Group”) paid approximately $1,850,000. The whistleblower was a former employee of the Pandya Practice Group. For reporting the false claims billed to Medicare, the whistleblower is entitled to a reward which can be up to 25% of the amount of money the government recovers from the practice group if the government intervenes.
This Medicare fraud scheme allegedly entailed the physician falsely diagnosing patients with glaucoma, which allowed her to bill the federally-funded healthcare program for glaucoma-related testing and procedures. The physician also allegedly “performed medically unnecessary cataract extraction surgeries and YAG laser capsulotomies” on patients who did not have these conditions to bill Medicare for the procedures. The allegations also detail that the tests that the physician ordered were done with broken equipment or otherwise botched, so that Medicare was billed for care that wasn’t performed correctly.
Medicare fraud harms patients and taxpayers and can take a variety of forms, including performing unnecessary medical procedures on patients who do not have the condition with which they have been purportedly diagnosed. To cover fraud’s drain on financial resources for Medicare, premiums and taxes must increase to keep the program solvent, which impacts both current and future beneficiaries. One U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) official best summed up the ripple effect of Medicare fraud, “Subjecting individuals to extraneous procedures just to bilk the health care programs on which they rely is the antithesis of proper medical care.”
Whistleblowers have protections from retaliation under the False Claims Act and can earn significant rewards for speaking up and doing the right thing.
If you would like to report Medicare fraud, contact the whistleblower attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Eva was the Senior Counsel for Health Care Fraud. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Eva Gunasekera at [email protected] or contact Renée at [email protected] (tel.: 202-417-3664). Visit Tycko & Zavareei LLP’s website for whistleblowers to learn more at https://www.fraudfighters.net/.