Michael Barbella, Managing Editor05.26.23
Michigan vascular surgeon Vasso Godiali has received an 80-month prison term for orchestrating a multimillion-dollar scheme to defraud healthcare programs by submitting claims for vascular stent placements and thrombectomies he did not perform. Godiali must pay $19.5 million in restitution to Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan (BCBSM), and he also agreed to pay the United States government up to $43,419,000 to resolve related civil allegations that his fraudulent billings to federal healthcare programs violated the False Claims Act (FCA).
According to a plea agreement that Godiali entered on Feb. 8, 2022, Godiali began to knowingly defraud medical insurers, including Medicare and Medicaid, in approximately 2009. The Bay City, Mich., surgeon 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. But Godiali did not place those stents and admitted to billing for services never rendered while preparing materially inaccurate medical records to justify the fraudulent billings.
“We will not tolerate the use of federal healthcare programs as a source of personal enrichment,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement demonstrates our commitment to protecting the integrity of those programs and the taxpayer funds used to support them.”
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 siphoned $14,473,000 from the federal government, and $19.5 million from Medicare, Medicaid, and BCBSM.
“This provider egregiously stole millions of dollars from taxpayers by billing federal health care programs for services that were neither medically necessary nor rendered to his patients,” said Special Agent in Charge Mario M. Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “As this case demonstrates, HHS-OIG and our partners remain committed to ensuring that vital taxpayer dollars are used lawfully and for their intended purposes, not for the illegitimate financial gain of an individual provider.”
In the related FCA action, in addition to alleging that Godiali submitted false claims for procedures that he never performed, the United States accused the surgeon of improperly using Modifier 59 to “unbundle” services that should have been billed together in a single claim to increase his reimbursements from federal healthcare programs.
Through a civil forfeiture case, federal authorities seized approximately $39.9 million from financial accounts Godiali controlled. Except for $7.5 million, which will be released to Godiali’s wife pursuant to 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.” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “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 the sentence and substantial civil recovery deter any other physicians likewise inclined to line their pockets at the expense of the public.”
“The scope of Godiali’s fraud is truly stunning,” said Special Agent in Charge James A. Tarasca of the FBI Detroit Field Office. “This investigation proves the collective resources of law enforcement and the private sector can successfully combat fraud in our healthcare system.”
The civil settlement includes the resolution of claims brought under the qui tam or 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 $4,341,900.
The criminal case was prosecuted by Assistant U.S. Attorneys John Neal, Philip Ross, and Craig Wininger for the Eastern District of Michigan. The FCA matter was handled by Senior Trial Counsel Sarah Arni of the Justice Department’s Civil Division and Assistant U.S. Attorney John Postulka for the Eastern District of Michigan. The civil forfeiture action was handled by Assistant U.S. Attorney Philip Ross for the Eastern District of Michigan. These matters received assistance from HHS-OIG, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Office of Inspector General.
According to a plea agreement that Godiali entered on Feb. 8, 2022, Godiali began to knowingly defraud medical insurers, including Medicare and Medicaid, in approximately 2009. The Bay City, Mich., surgeon 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. But Godiali did not place those stents and admitted to billing for services never rendered while preparing materially inaccurate medical records to justify the fraudulent billings.
“We will not tolerate the use of federal healthcare programs as a source of personal enrichment,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement demonstrates our commitment to protecting the integrity of those programs and the taxpayer funds used to support them.”
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 siphoned $14,473,000 from the federal government, and $19.5 million from Medicare, Medicaid, and BCBSM.
“This provider egregiously stole millions of dollars from taxpayers by billing federal health care programs for services that were neither medically necessary nor rendered to his patients,” said Special Agent in Charge Mario M. Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “As this case demonstrates, HHS-OIG and our partners remain committed to ensuring that vital taxpayer dollars are used lawfully and for their intended purposes, not for the illegitimate financial gain of an individual provider.”
In the related FCA action, in addition to alleging that Godiali submitted false claims for procedures that he never performed, the United States accused the surgeon of improperly using Modifier 59 to “unbundle” services that should have been billed together in a single claim to increase his reimbursements from federal healthcare programs.
Through a civil forfeiture case, federal authorities seized approximately $39.9 million from financial accounts Godiali controlled. Except for $7.5 million, which will be released to Godiali’s wife pursuant to 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.” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “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 the sentence and substantial civil recovery deter any other physicians likewise inclined to line their pockets at the expense of the public.”
“The scope of Godiali’s fraud is truly stunning,” said Special Agent in Charge James A. Tarasca of the FBI Detroit Field Office. “This investigation proves the collective resources of law enforcement and the private sector can successfully combat fraud in our healthcare system.”
The civil settlement includes the resolution of claims brought under the qui tam or 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 $4,341,900.
The criminal case was prosecuted by Assistant U.S. Attorneys John Neal, Philip Ross, and Craig Wininger for the Eastern District of Michigan. The FCA matter was handled by Senior Trial Counsel Sarah Arni of the Justice Department’s Civil Division and Assistant U.S. Attorney John Postulka for the Eastern District of Michigan. The civil forfeiture action was handled by Assistant U.S. Attorney Philip Ross for the Eastern District of Michigan. These matters received assistance from HHS-OIG, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Office of Inspector General.
