The following cases highlight fraud, waste, and abuse (FWA) and serve as a reminder to uphold high ethical standards when providing patient care and services. 

In its complaint, the United States alleged that the interventional radiologist, his practices, and his management entities billed Medicare and the Federal Employees' Health Benefits Program for medically unnecessary invasive peripheral artery procedures in patients' legs between at least January 1, 2016, and December 31, 2019.

The complaint also alleges that they were reimbursed at least $6.5 million dollars for over 500 claims.

The allegations regarding unnecessary vascular procedures are described in detail in the complaint and include unnecessary angioplasty, atherectomy, and the placement of stents, as well as the indiscriminate use of intravenous ultrasound. Each procedure requires puncturing the skin and inserting devices into and through the arteries in patients' legs. As the relevant standards of care indicate, unnecessary invasive vascular procedures may cause harm to patients' health, including increasing their likelihood of needing future procedures, and putting them at greater risk of leg amputations.

As alleged, the parties knew from prior administrative sanctioning that unnecessary procedures are contrary to standards of care and federal law. 

The interventional radiologist was previously sanctioned in other states' medical boards and Medicaid programs for improperly performing unnecessary, experimental vascular procedures, including angioplasty and stenting. These procedures were performed on hundreds of patients for the purported treatment of multiple sclerosis, a non-vascular disease.

Read the specifics of this case at www.justice.gov.

The complaint alleges that from approximately August 2014 to August 2019, this plastic surgeon submitted or caused to be submitted false claims for healthcare services to government payors, including Medicare. The complaint alleges that the plastic surgeon: (1) billed government payors for services he claimed were medically necessary surgical procedures, but were in actuality medically unnecessary cosmetic surgeries, which are not payable by government payors; (2) billed for services in excess of those actually rendered (upcoding) to increase reimbursement, or even billed for surgical procedures he didn't perform at all; and (3) overstated the complexity of office visits with patients in order to obtain greater reimbursement from government payors.

Read more about this case at www.justice.gov.

A jury found that almost 65,000 false claims were submitted to Medicare, which resulted in over $43 million in damages to Medicare.

As proven at trial, a leading ophthalmic surgical distributor provided kickbacks to ophthalmic physicians and surgeons in various forms, including travel and entertainment. Multiple examples of trips were identified, including high-end skiing, fishing, golfing, hunting, sporting, and entertainment vacations, often at exclusive destinations. For many of the trips, the distributor transported these physicians to luxury vacation destinations on private jets. These included trips to New York City to see a Broadway musical, the College Football National Championship Game in Miami, Florida, and the Masters golf tournament in Augusta, Georgia. The distributor also sold frequent flyer miles to their physician customers at a significant discount, enabling the physicians to take personal and business trips at well below fair market value.

A Deputy Civil Chief for the United States Attorney's Office on the case stated, "Medicare beneficiaries are entitled to know with certainty that their physician's decision-making has not been compromised by a private flight, expensive ski-trip, or any other unlawful inducement. This office is committed to investigating misconduct and recovering funds unlawfully obtained from federal healthcare programs."

Read additional details of this case at www.justice.gov.