An Indian-origin doctor in the US, Dr Jitesh Patel, and his Atlanta-based urology facility, Advanced Urology, have agreed to pay $14 million to settle federal allegations of healthcare fraud involving unnecessary medical procedures on patients.
According to the US Department of Justice (US DOJ) press release issued by the US Attorney’s Office for the Northern District of Georgia on April 2, the Atlanta-based Advanced Urology, and Patel would pay the amount to resolve claims that they violated the False Claims Act and the Georgia False Medicaid Claims Act.
The practice allegedly billed Medicare, Medicaid, TRICARE, and other federal healthcare programs for urological and diagnostic procedures that were either never performed or were medically unnecessary. The government’s multi-agency investigation — involving the FBI — began after two whistle-blowers filed lawsuits.
DR PATEL, HIS FACILITY PERFORMED INVASIVE TESTS ON NEARLY EVERY NEW PATIENT: LAWSUIT
According to the DOJ press release, the whistle-blowers are Lorraine Perumal-Szramel, a former employee of Advanced Urology, and Dr Himanshu Aggarwal, a former physician at the facility.
They alleged that Advanced Urology’s organisation was designed to maximise revenue for Patel and others through systematic malpractices, including:
- Implanting permanent sacral nerve stimulator devices in patients without first determining whether the devices would actually benefit them.
- Performing numerous unnecessary cystoscopies and retrograde pyelogram procedures, which involved placing patients under anaesthesia and inserting a scope through the urethra into the bladder.
- Conducting electromyography tests on almost every new patient, even though such tests are rarely used in standard urology practices. These tests involved transmitting electrical signals through an electrode attached to the patient’s genitalia.
- Ordering thousands of unnecessary ultrasound tests, including duplex and retroperitoneal ultrasounds.
- Billing for Direct Visual Internal Urethrotomy (DVIU) — a procedure that uses a scope and knife to cut tissue inside the urethra — while allegedly performing only a simpler dilation and charging the higher rate for the more complex surgery.
American local outlet, FOX 5 Atlanta, reported that Patel and his practice performed invasive tests on nearly every new patient and billed for surgeries that were never actually performed.
The outlet also noted “upcoding” of less complicated procedures to more expensive ones and reported that it remained unclear whether any patients suffered long-term physical harm from the alleged unnecessary procedures, such as electrical signal tests or bladder scopes.
According to the DOJ press release, the settlement resolves two federal lawsuits filed in the US District Court for the Northern District of Georgia by the whistle-blowers, Lorraine Perumal-Szramel and Dr Himanshu Aggarwal. The two whistle-blowers would collectively receive $2.94 million from the recovery.
US Attorney Theodore S Hertzberg was quoted by the DOJ as stating, “Physicians commit fraud when they seek payment for medically unnecessary procedures or bill for services they never performed.”
Georgia Deputy Attorney General Jim Mooney said, “Fraud against the Medicaid program is stealing from Georgia taxpayers, plain and simple.”
FBI Special Agent Peter Ellis noted that the scheme prioritised “profit over patient care.”
FOX 5 Atlanta reported that such practices divert limited healthcare resources away from patients who truly need them, including Medicaid users and veterans relying on TRICARE or VA programs. Officials from HHS-OIG, the FBI, VA OIG, and the Department of Defense (now renamed the Department of War) have vowed to continue protecting federal healthcare funds and patients from abuse.
The $14 million civil settlement resolves only the allegations as there has been no formal determination of liability or admission of wrongdoing by Patel or his practice.
The multi-agency investigation involved the US Attorney’s Office, the US Department of Health and Human Services, Georgia Attorney General’s Medicaid Fraud and Patient Protection Division, the FBI, VA OIG, and Defence Criminal Investigative Service.
– Ends
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