Advanced Urology and Jitesh Patel will pay $14 million to settle False Claims Act case involving allegations of fraudulent billing and unnecessary medical procedures

ATLANTA -Jitesh Patel, M.D., Advanced Urology, Inc., and affiliated companies (collectively "Advanced Urology") will pay $14 million to settle allegations that they violated the False Claims Act and the Georgia False Medicaid Claims Act by billing federal healthcare programs, including Medicare and Medicaid, for a series of urological and diagnostic procedures that were not performed or were medically unnecessary.

"Physicians commit fraud when they seek payment for medically unnecessary procedures or bill for services they never performed," said U.S. Attorney Theodore S. Hertzberg. "Our office will not tolerate abuse of patients or misuse of government funds, and we will enforce the False Claims Act to hold wrongdoers accountable."

"Today's action underscores our commitment to safeguarding federal health care programs from fraud and abuse," said Special Agent in Charge Kelly Blackmon of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). "Allegations of upcoding and medically unnecessary procedures undermine the integrity of Medicare and other government programs. We will continue working closely with our law enforcement partners to ensure that providers who submit false claims are held accountable."

"This settlement underscores the FBI's commitment to investigating complex healthcare fraud schemes that prioritize profit over patient care," said Peter Ellis, Acting Special Agent in Charge of FBI Georgia. "Submitting false claims to federal healthcare programs is a serious violation of the law, and we will continue to ensure those responsible are held accountable."

"This settlement demonstrates the VA OIG's tireless commitment to protecting veterans' healthcare programs from fraudulent billing," said Special Agent in Charge David Spilker with the VA Office of Inspector General's Southeast Field Office. "The VA OIG thanks the US Attorney's Office and our law enforcement partners for their efforts in this investigation."

"Fraud against the Medicaid program is stealing from Georgia taxpayers - plain and simple," said Jim Mooney, Deputy Attorney General of Georgia's Medicaid Fraud and Patient Protection Division. "Performing unnecessary procedures takes limited resources away from those who truly need them. This office will ensure that Medicaid providers treat their patients and Georgia taxpayers with respect and not as a scheme to get rich."

"This settlement should serve as a strong deterrent to healthcare practitioners who abandon their Hippocratic Oath while seeking to exploit and defraud TRICARE, which provides critical healthcare services to those who defend our nation, retirees, and their families," said Jason Sargenski, Special Agent in Charge, Department of Defense, Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office. "DCIS, alongside our law enforcement partners, will continue to aggressively investigate allegations of healthcare providers who defraud the U.S. Government, and will seek justice on behalf of our men and women in uniform."

The government's investigation began after a former Advanced Urology employee filed a whistleblower complaint alleging that Advanced Urology performed unnecessary procedures. A former Advanced Urology physician filed a second whistleblower complaint alleging that the practice billed government healthcare programs for procedures and tests that were not performed or were medically unnecessary.

The whistleblowers alleged, among other things, that Advanced Urology's organization was designed to maximize revenue for Dr. Patel and others by performing medically unnecessary procedures and tests, by engaging in the following practices, among others:

• Implanting permanent Sacral Nerve Stimulator devices in patients without first determining whether the patients would benefit from the device.
• Performing numerous unnecessary Cystoscopy and Retrograde Pyelogram procedures, which involved placing a patient under anesthesia and inserting a small scope through the patient's urethra and into the bladder.
• Performing an Electromyography test on almost every new patient at Advanced Urology even though it is rarely used in urology practices. This test involved transmitting electrical signals through an electrode attached to the patient's genitalia.
• Ordering thousands of unnecessary ultrasound tests, including duplex ultrasounds and retroperitoneal ultrasounds.

The whistleblowers also alleged that Advanced Urology billed for a procedure known as Direct Visual Internal Urethrotomy ("DVIU") that it never performed. The DVIU procedure involves using a scope to dilate a patient's urethra and a knife to cut tissue inside the urethra. Allegedly, Advanced Urology performed a less complicated dilation of the urethra but billed government healthcare programs for DVIU to obtain more payment than it was owed.

The whistleblowers alleged that Advanced Urology and Dr. Patel's conduct resulted in the submission of false claims to federal healthcare programs, including Medicare and Medicaid, in violation of the False Claims Act, 31 U.S.C. §§ 3729, et seq., and the Georgia False Medicaid Claims Act, O.C.G.A. §§ 49-4-168.1, et seq.

This civil settlement resolves two lawsuits filed in the U.S. District Court for the Northern District of Georgia under the qui tam or whistleblower provisions of the False Claims Act: United States and State of Georgia ex rel. Lorraine Perumal-Szramel v. Advanced Urology, Inc. et al., No. 1:18-cv-4482-SCJ, and United States and State of Georgia ex rel. Himanshu Aggarwal, M.D. v. Jitesh V. Patel et al., No. 1:19-cv-2844-WMR.

Under the False Claims Act, private citizens may bring suit for false claims on behalf of the United States and share in any recovery obtained by the government. The Relators will collectively receive $2,940,000 from the settlement.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

This case was investigated by the U.S. Attorney's Office for the Northern District of Georgia; the U.S. Department of Health and Human Services, Office of Inspector General; the Medicaid Fraud and Patient Protection Division of the Georgia Attorney General's Office; the Federal Bureau of Investigation; the Department of Veterans Affairs, Office of the Inspector General; and the Defense Health Agency.

The investigation and resolution of this matter was handled by Assistant U.S. Attorneys Adam D. Nugent and Andres Sandoval and Georgia Assistant Attorney General James Champlin.

For further information please contact the U.S. Attorney's Public Affairs Office at [email protected] or (404) 581-6016. The Internet address for the U.S. Attorney's Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.