Georgia ophthalmologist antes up $1.8 million to settle unnecessary billing allegation

According to a news release this week from the U.S. Attorney’s Office, the settlement resolves allegations in a lawsuit filed by Laura Dildine, a former Pandya Practice Group employee, under the qui tam, or whistleblower, provisions of the False Claims Act.

Aarti D. Pandya, MD, and the Pandya Practice Group agreed to pay approximately $1,850,000 to resolve allegations that they violated the False Claims Act by, among other things, billing the government for cataract surgeries and diagnostic tests that were not medically necessary, tests that were incomplete or of worthless value, and office visits that did not provide the level of service claimed.

“Physicians who perform procedures and tests without a legitimate medical need place profits ahead of patients and subject those patients to unnecessary risk,” U.S. Attorney Ryan K. Buchanan said in a news release. “This settlement represents our office’s commitment to ensuring accountability for physicians who subject patients to unwarranted medical care and waste taxpayer funds.”

According to a news release this week from the U.S. Attorney’s Office, the settlement resolves allegations in a lawsuit filed by Laura Dildine, a former Pandya Practice Group employee, under the qui tam, or whistleblower, provisions of the False Claims Act (FCA).

The allegations resolved in the settlement stem from January 1, 2011, to December 31, 2016, in which Pandya allegedly submitted false claims to federal healthcare programs for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies.

The news release noted that the government alleged that Pandya performed these procedures on patients that did not qualify for the procedure under accepted standards of medical practice and, in some cases, caused injury to her patients. Additionally, the government alleged that Pandya falsely diagnosed patients with glaucoma to justify unnecessary diagnostic testing and treatment that was billed to Medicare. The government alleged that many of the diagnostic tests that Pandya ordered were not properly performed, were performed on a broken machine, or were not interpreted in the medical record, as required by Medicare.

The lawsuit, according to court records, was filed in the Northern District of Georgia and is captioned United States ex rel. Dildine v. Aarti D. Pandya, M.D. et al., No. 1:13-CV-3336-LMM. The United States intervened in this lawsuit in 2018.

After the government intervened in the qui tam action, HHS imposed a payment suspension on the Pandya Practice Group that precluded it from receiving any reimbursement from Medicare for Part B claims.

The payment suspension was imposed on October 23, 2019. Pandya and the Pandya Practice Group unsuccessfully challenged the payment suspension in district court. As part of the settlement of the government’s claims in this case, the Pandya Practice Group agreed to forfeit the suspension amount to the government. The payment suspension will also be lifted as part of the settlement.

Keri Farley, Special Agent in Charge of FBI Atlanta, noted that it is imperative to ensure that patients and taxpayers that healthcare is dictated by clinical needs, not fiscal greed.

“This settlement should serve as a reminder that the FBI will not tolerate healthcare providers who engage in schemes that defraud the industry and put innocent patients at risk,” she said in the news release.

Special Agent in Charge Tamala E. Miles with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), noted in the news release that care coordination for beneficiaries should account, first and foremost, for the medical appropriateness of services that patients need to maintain their well-being.

“Subjecting individuals to extraneous procedures just to bilk the health care programs on which they rely is the antithesis of proper medical care. HHS-OIG and our law enforcement partners are dedicated to investigating providers who allegedly threaten the safety of patients and the integrity of the federal health care system.”

Special Agent in Charge Darrin K. Jones, DoD Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office, pointed out that the agency is committed to fully investigating providers who falsely bill the Department of Defense (DoD) health care system to enrich themselves using funds intended for military members and their families.

“We thank the U.S. Attorney’s Office and our investigative partners for their dedication to protecting America’s warfighters,” he said.

The investigation of this matter and the litigation against Aarti D. Pandya, M.D., and the Pandya Practice Group were handled by Assistant U.S. Attorneys David A. O’Neal, Austin M. Hall, and Akash Desai. The claims resolved by the settlement are allegations only, and there has been no determination of liability.