The government intervened and filed a complaint in a False Claims Act lawsuit against Aarti D. Pandya, M.D. a/k/a Arati D. Pandya, M.D., an ophthalmologist from Conyers, Georgia, and her practice Aarti D. Pandya, M.D., P.C. (“the Pandya Defendants”). The lawsuit alleges that the Pandya Defendants submitted false claims to Medicare for surgical procedures, diagnostic tests, and office visits that were medically unnecessary, of worthless value, upcoded, and in some cases, not provided at all.
“Patients and taxpayers who finance health care programs like Medicare are entitled to know that doctors are making decisions solely based upon medical need, and not based upon a desire to increase billings,” said U.S. Attorney Byung J. “BJay” Pak. “Our office is committed to preserving the integrity of the public health programs by pursuing doctors who engage in illegal healthcare practices at the public’s expense.”
“Greed at the expense of the American taxpayer is unacceptable,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG) in Atlanta. “HHS-OIG in tandem with our law enforcement partners will vigorously pursue those who seek to harm our most vulnerable citizens through questionable medical procedures and billing practices.”
“We must ensure patients and taxpayers that care provided by federally funded healthcare programs is dictated by clinical needs, not fiscal greed,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “To do that, the FBI and its partners are committed to combine resources to investigate and hold providers accountable to bill the government only for necessary services.”
The government’s complaint alleges that, between January 1, 2011 and December 31, 2016, Dr. Pandya engaged in multiple schemes to submit false claims to Medicare, including claims for medically unnecessary cataract extraction surgery. Cataract surgery is only justified when a patient has a cataract that advances to the point where the patient cannot see well enough to carry out their normal daily activities. In many cases, Dr. Pandya performed surgery despite the fact that her patients had little to no vision complaints and normal visual acuity. She also failed to determine whether the patient would benefit from less invasive measures, such as glasses, as is required before submitting Medicare claims for cataract surgery.
The complaint also alleges that Dr. Pandya rendered false glaucoma diagnoses, which she used to submit a battery medically unnecessary diagnostic tests to Medicare. These diagnostic tests were often incomplete, of extremely poor quality, and not used by Dr. Pandya in treating the patients. For a period of time, one of the machines that Dr. Pandya used for diagnostic testing was not functioning, but she continued to bill Medicare for these tests, which were never performed.
The complaint also alleges that the Pandya Defendants submitted large numbers of false claims for office visits, commonly referred to as evaluation and management services. The Pandya Defendants billed Medicare for high level office visits nearly every time patients visited the clinic. Dr. Pandya, however, spent very little time with her patients and failed to provide the services required of these high level office visits. The Pandya Defendants also filed false claims for office visits when patients came to the clinic for care associated with procedures for which Medicare was already paying.
The lawsuit was initially filed by Laura Dildine, a former office manager for the Pandya Defendants, under the qui tam, or whistleblower, provisions of the False Claims Act. Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. The act permits the government to intervene in such lawsuits, as it has done in this case. Defendants found liable under the act are subject to treble damages and penalties.
This matter was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the Department of Health and Human Services – Office of Inspector General, the Federal Bureau of Investigation, and the Defense Criminal Investigative Service.
The claims asserted against the defendant are allegations only, and there has been no determination of liability. The lawsuit is captioned United States v. Aarti D. Pandya, M.D., et al., Civil Action No. 1:13-CV-3336-LMM. (N.D. Ga.)
Assistant U.S. Attorneys David O’Neal and Austin M. Hall are representing the United States in this matter.