Healthcare Providers Face Crackdown Over False Billing Allegations

Clear Facts

• A Georgia medical doctor and his practice agreed to pay $14 million to resolve allegations of healthcare fraud.
• Investigators said the group billed for unnecessary diagnostic services and urological procedures that were never performed.
• Two former employees acted as whistleblowers and will receive nearly $3 million from the settlement.

A Georgia medical doctor and his practice agreed to pay $14 million to resolve allegations of systematic healthcare fraud against federal and state programs.

The settlement follows accusations that the group billed for unnecessary diagnostic services and urological procedures that were never performed.

Advanced Urology, Inc. allegedly performed unnecessary cystoscopies and ultrasounds to maximize revenue for Dr. Jitesh Patel and affiliated entities.

Whistleblowers claimed the practice implanted permanent nerve stimulator devices in patients without first determining if the medical necessity existed.

Investigators found evidence of billing for complex surgeries that were actually simpler, less expensive procedures, a practice often called upcoding.

The investigation was sparked by two former employees who acted as whistleblowers under the False Claims Act to expose the exploitation of government funds.

These individuals will receive nearly $3 million of the settlement for their role in bringing the alleged misconduct to light.

“Physicians commit fraud when they seek payment for medically unnecessary procedures or bill for services they never performed,” said U.S. Attorney Theodore S. Hertzberg.

“Our office will not tolerate abuse of patients or misuse of government funds, and we will enforce the False Claims Act to hold wrongdoers accountable.”

The Georgia Attorney General’s office emphasized that fraud against Medicaid is equivalent to stealing directly from the hardworking taxpayers of Georgia.

Officials noted that performing unneeded procedures diverts limited resources away from those who truly require medical attention.

“Fraud against the Medicaid program is stealing from Georgia taxpayers – plain and simple,” said Jim Mooney, Deputy Attorney General of Georgia’s Medicaid Fraud Division.

“This office will ensure that Medicaid providers treat their patients and Georgia taxpayers with respect and not as a scheme to get rich.”

The settlement involves multiple federal agencies including the FBI and the Department of Veterans Affairs.

Each agency confirmed its commitment to protecting the integrity of healthcare programs meant for veterans and active-duty service members.

“The settlement underscores the FBI’s commitment to investigating complex healthcare fraud schemes that prioritize profit over patient care,” said Peter Ellis, Acting Special Agent in Charge of FBI Georgia.

“Submitting false claims to federal healthcare programs is a serious violation of the law, and we will continue to ensure those responsible are held accountable.”

While the $14 million payment resolves the legal claims, the settlement contains no formal determination of liability by the defendants.

The case highlights the ongoing necessity of oversight to protect American taxpayers and the sanctity of the medical profession.