Michigan surgeon bilks insurers for $19.5 million

Michigan surgeon bilks insurers for $19.5 million | Insurance Business America

Michigan surgeon bilks insurers for $19.5 million

A Michigan vascular surgeon has pleaded guilty to participating in a scam that bilked Medicare, Medicaid and Blue Cross/Blue Shield out of approximately $19.5 million, according to the Department of Justice.

Dr. Vasso Godiali, 49, faces up to 10 years in prison at his sentencing in September, according to Dawn M. Ison, US attorney for the Eastern District of Michigan.

According to the plea agreement, Godiali began knowingly defrauding the insurers around 2009 by causing the submission of false billing. That false billing included claims for the replacement of stents in dialysis patients and for the treatment of arterial blood clots. Godiali admitted that he billed for the placement of multiple stents in the same vessel and prepared medical records supposedly documenting the medical necessity justifying that billing.

However, Godiali did not place those stents. He admitted in the plea agreement to billing the insurers for services never rendered while preparing “materially inaccurate” medical records to justify the billing, the Justice Department said.

With respect to the blood clots, Godiali admitted that his medical records would describe finding occluded arteries that appeared to justify performing arterial thrombectomies. In fact, Godiali admitted that he often encountered no such occlusions and performed no such procedures.

Read next: Chicken magnates hatch bird-brained workers’ comp scam

“The scale of Dr. Godiali’s fraud is stunning, and his willingness to illegally enrich himself at the expense of our district’s taxpayers and policyholders is egregious,” Ison said. “Brazen schemes like this have no place in our district, and today’s guilty plea reflects my office’s commitment to holding medical providers accountable when they abuse society’s mistrust by engaging in such misconduct.”

Under the terms of the plea deal, Goldiali will be required to pay $19.5 million in restitution to Medicare, Medicaid and Blue Cross Blue Shield of Michigan. A civil forfeiture case against approximately $39.9 million seized from his accounts is still pending, the Justice Department said.