Vascular Surgeon Indicted On $60 Million Healthcare Fraud, Money Laundering

15 Jul, 2019 F.J. Thomas

                               

Bay City, MI (WorkersCompensation.com) – A Michigan vascular surgeon has been indicted on charges of healthcare fraud and money laundering. A Department of Justice press release detailed the charges against says 56-year-old Vasso Godiali, M.D.  Godiali is affiliated with several area hospitals including St. Marys of Michigan, and McLaren Bay Region.

According to the indictment released by the DOJ, Godiali is accused of submitting false claims for implantation of stents for the treatment of arterial blood clots, and in patients with kidney failure that were on dialysis. Additionally, the DOJ alleges that Godiali exploited the use of ‘modifier 59’ to receive higher reimbursement due to unbundling of claims. The total reimbursement received through the alleged fraudulent claims is $60 million from Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.

In addition to the charges for healthcare fraud, Godiali is also accused of money laundering of approximately $49 million through six different corporations. Godiali is said to have used the money to fund his own personal investments through multiple financial institutions. He also used the money to pay property taxes on in his real estate in Houghton Lake. A civil suit has also been filed by the United States Attorney’s Office for $39.9 million.

Michigan Attorney General Dana Nessel  expressed concern over the amount involved in the case stating, “Flagrant efforts to scam Medicare, Medicaid and Blue Cross Blue Shield of Michigan are despicable in any degree—but particularly so when tens of millions of dollars are involved.  Thanks to United States Attorney Matthew Schneider and his team along with the efforts of our own Health Care Fraud Unit and the Michigan Department of Health and Human Services Office of Inspector General staff, which initiated the early investigation into this alleged health care fraud scheme, it has come to a halt”

Modifier 59, which signifies a distinct procedural service, has been on the OIG radar for several years. In a CMS report released in 2017, the OIG reported inappropriate use of modifier 59 by hospitals.

Additionally, a 2018 OIG Audit at the University of Michigan Health System also revealed inappropriate use of modifier 59. Six of 30 sampled claims were billed incorrectly resulting in overpayments.

 


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    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

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