(The Center Square) – A Bay City vascular surgeon was sentenced on May 3 to 6.6 years in prison for orchestrating a multimillion-dollar scheme to defraud taxpayers and health care programs.
Court records say Vasso Godiali submitted claims for the placement of vascular stents and for thrombectomies that he didn’t perform and was ordered to pay $19.5 million in restitution collectively to Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan.
Godiali agreed to pay the United States up to $43.4 million to resolve related civil allegations that his fraudulent billings to federal health care programs violated the False Claims Act.
A plea agreement Godiali entered on Feb. 8, 2022, says Godiali began to knowingly defraud medical insurers in 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. However, Godiali didn’t 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 $14.4 million 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.
“We will not tolerate the use of federal health care programs as a source of personal enrichment,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said in a statement. “Today’s settlement demonstrates our commitment to protecting the integrity of those programs and the taxpayer funds used to support them.”
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 about $39.9 million from financial accounts controlled by Godiali. Except for $7.5 million, which will be released to Godiali’s wife under an agreement with the United States, all of the seized funds will be used to pay the criminal judgment or the FCA settlement.
“A priority of my office is protecting our district against unscrupulous health care providers,” U.S. Attorney Dawn N. Ison for the Eastern District of Michigan said in a statement. “Dr. Godiali stole an enormous amount of money from both public and private health insurers over a number of years, and falsified medical records to cover up his scheme to defraud. We hope that today’s sentence and substantial civil recovery deter any other physicians likewise inclined to line their pockets at the expense of the public.”
The civil settlement includes the resolution of claims brought under whistleblower provisions of the False Claims Act by Innovative Solutions Consulting, LLC. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.
As part of the civil resolution, Innovative Solutions will receive up to $4.3 million
“The scope of Godiali’s fraud is truly stunning,” Special Agent in Charge James A. Tarasca of the FBI Detroit Field Office said in a statement. “This investigation proves the collective resources of law enforcement and the private sector can successfully combat fraud in our health care system.”
This article First appeared in the center square