In last week’s blog, we tackled the topic of medical errors. We highlighted the fact that 80% of all medical bills contain billing errors. The blog noted that a mix of clerical and coding errors are often culprits for the mistakes made on many of the bills sent to patients. Sadly, fraud is another major reason that so many people see mistakes on their medical bills. People like Dr. Vasso Godiali contribute to this problem.
Dr. Godiali has pleaded guilty to defrauding three insurers.
As reported by the Eastern District of Michigan branch of the United States Department of Justice, the 59 year-old pleaded guilty to his ruse earlier this week. Godiali admitted to participating in a scheme to defraud Medicare, Medicaid and Blue Cross/Blue Shield out of approximately $19.5 million. The vascular surgeon knowingly defrauded the three medical insurers in and around 2009.
To conduct his scam, Godiali submitted false and fraudulent billing including admissions related to claims for the placement of stents in dialysis patients. He also submitted fraudulent bills for the treatment of arterial blood clots. Godiali also admitted that he billed for the placement of multiple stents in the same vessel. As well, he prepared medical records purporting to document the medical necessity that justified the billing.
Godiali did not perform the procedures he submitted claims for.
As the DoJ reports, Godiali did not place those stents. He confessed to billing the insurers for services he never rendered. As well, he admitted to preparing materially inaccurate medical records to justify the fraudulent billing. The plea agreement also documents similar misconduct regarding arterial blood clots.
“Godiali acknowledged that his medical records would describe encountering occluded arteries that would appear to justify the performance of arterial thrombectomies,” explains the DoJ reports, “In fact, as Godiali 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.”
United States Attorney Dawn N. Ison made the announcement of Godial’s guilty plea.
“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,” she is quoted as saying in the report, “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 trust by engaging in such misconduct.”
Godiali is scheduled for sentencing on September 15, 2022. He faces up to ten years’ imprisonment as well as the forfeiture of $19.5 million. Under the terms of the plea agreement, the doctor will be required to pay the money in restitution to Medicare, Medicaid and Blue Cross Blue Shield of Michigan.
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