On July 10, 2019, United States Attorney Matthew Schneider announced the indictment of Dr. Vasso Godiali of Bay City, charged with health care fraud in the amount of $60 million, and money laundering for financial transactions involving approximately $49 million in proceeds derived from the scheme.
According to the indictment, Dr. Godiali submitted false and fraudulent claims for the placement of stents in dialysis patients and for the treatment of arterial blood clots; exploited medical billing software to improperly maximize payments from Medicare, Medicaid, and Blue Cross Blue Shield of Michigan; submitted false and fraudulent claims to Medicaid, Medicare, and Blue Cross for services not rendered; and “unbundled” claims by exploiting modifier-59 to falsely claim he was performing many separate and distinct procedures, when in fact he was entitled to a single reimbursement for a single procedure. The indictment further alleges that Dr. Godiali utilized six corporations through which he laundered approximately $49 million, which he ultimately used to fund investment accounts at multiple financial institutions, and that he engaged in money laundering by using proceeds from his scheme to pay property taxes on a Houghton Lake, Michigan, residence.
The United States Attorney’s Office also filed a related civil lawsuit seeking the forfeiture of approximately $39.9 million seized from accounts controlled by Dr. Godiali and/or related to four separate real estate transactions.
If convicted, Dr. Godiali faces a maximum sentence of imprisonment of ten years and a maximum fine of $250,000 on each count for the health care fraud charges, and a maximum sentence of twenty years of imprisonment, and a maximum fine of twice the amount laundered for the money laundering charges.
An indictment is only a charge and is not evidence of guilt – each defendant is entitled to a fair trial in which it will be the government’s burden to provide guilt beyond a reasonable doubt.
Although the amounts at issue in this matter are unusually high, the allegations of billing for services not rendered, unbundling, and submitting false and fraudulent claims for various services are not new to health care enforcement authorities. In some circumstances, medical practices are unaware that they are incorrectly billing for services which can lead to serious criminal, administrative and civil actions against the providers, the practice and its employees. Often, medical practices that undertake proactive compliance measures are able to discover potential areas of incorrect billing and take remedial measures to avoid the significant adverse effects that could otherwise result. The Health Law Partners, P.C. regularly assist medical practices and providers in their compliance needs as well as defense of government investigations, third party payor investigations, payor/network departicipation, licensure and other adverse actions that can result from improper billing matters. For more information regarding such services, please contact please contact Robert S. Iwrey, Esq. at 248-996-8510 or firstname.lastname@example.org.