by Ben Vernia | May 27th, 2023
A Bay City, Michigan vascular surgeon was sentenced to 80 months in prison, and settled a whistleblower’s False Claims Act case for up to approximately $43 million, the Department of Justice announced on May 26. According to DOJ’s press release:
Vasso Godiali, a vascular surgeon from Bay City, Michigan, was sentenced on May 3 to 80 months in prison for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform and was ordered to pay $19.5 million in restitution collectively to Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan (BCBSM). Additionally, Godiali agreed to pay the United States up to $43,419,000 to resolve related civil allegations that his fraudulent billings to federal health care programs violated the False Claims Act (FCA).
According to a plea agreement that Godiali entered on Feb. 8, 2022, Godiali began to knowingly defraud medical insurers, including Medicare and Medicaid, in approximately 2009. Godiali billed for the placement of multiple vascular stents in the same blood vessel and prepared medical records purporting to document the medical necessity justifying that billing. In fact, however, Godiali did not place those stents and admitted to billing for services never rendered while preparing materially inaccurate medical records to justify the fraudulent billings.
Godiali also billed for arterial thrombectomies and created medical records that stated he encountered occluded arteries that would justify the performance of the procedures. However, he admitted that he often encountered no such occlusions, performed no such thrombectomies, and thus billed insurers for services never rendered while preparing false medical records to justify the fraudulent claims. Godiali’s fraudulent practices resulted in $14,473,000 in damages to the federal government, and a total of $19.5 million across Medicare, Medicaid, and BCBSM, which he agreed to repay as restitution as part of his plea agreement.
In the related FCA action, in addition to alleging that Godiali submitted false claims for procedures that he never performed, the United States alleged that Godiali improperly used Modifier 59 to “unbundle” services that should have been billed together in a single claim to increase his reimbursements from federal health care programs.
A civil forfeiture case resulted in the seizure of approximately $39.9 million from financial accounts controlled by Godiali. Except for $7.5 million, which will be released to Godiali’s wife pursuant to an agreement with the United States, all of the seized funds will be used to pay the criminal judgment or the FCA settlement.
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The whistleblower, identified only as a limited liability company, will receive 10% of the settlement.
