Vascular surgeon in Michigan ordered to pay over $43 million to resolve False Claims Act allegations

Vasso Godiali, a vascular surgeon from Bay City, Michigan, has been sentenced to 80 months in prison for orchestrating a healthcare fraud scheme in which he submitted fraudulent claims for vascular stent placements and thrombectomies that he did not perform.  This resulted in multimillion-dollar losses for health care programs such as Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. As part of his sentencing, Godiali was ordered to pay $19.5 million in restitution collectively to the affected programs. In addition, he has agreed to pay up to $43,419,000 to settle civil allegations under the False Claims Act.

Godiali’s scheme involved billing for multiple vascular stents in the same blood vessel, even though the procedures were not performed. He also created false medical records to support his fraudulent claims for arterial thrombectomies, even though no occlusions were encountered. The total damages caused by the fraudulent practices amounted to $14,473,000 for the federal government alone. The case also involved allegations of improper use of Modifier 59, a billing code that inflated reimbursements from federal health care programs, which sometimes is an outright modifier violation and other times referred to as upcoding.

Whistleblower attorney Jason T. Brown commented on the case, saying, “Dr. Godiali’s fraud not only hurts the taxpayers but hurts the patients in which the quality of care is suspect when the profits are put before patients.  The substantial sentence and financial settlements demonstrate the commitment to protect the integrity of health care programs and hold accountable those who engage in Medicare Fraud. Whistleblowers continue to play a critical role in exposing such schemes, and their involvement in this case underscores the value of their contributions in combating fraud.”

The successful prosecution and resolution of the case were the result of collaboration between the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Eastern District of Michigan, the Department of Health and Human Services Office of Inspector General, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Office of Inspector General.