ATLANTA — An Atlanta urology practice and its physician will pay $14 million to settle allegations of healthcare fraud involving unnecessary procedures and billing for services that were never performed.
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The U.S. Attorney’s Office for the Northern District of Georgia says Jitesh Patel, M.D., and his practice, Advanced Urology, Inc., agreed to the settlement to resolve claims they violated federal and state laws, including the False Claims Act.
Federal investigators allege the practice billed government healthcare programs, Medicaid, and Medicare for procedures that were either medically unnecessary or not performed at all.
According to the government, two whistleblowers, a former employee and a former physician, filed lawsuits raising concerns about the practice’s billing and treatment patterns.
Those complaints allege the practice was structured to maximize revenue by performing excessive or unnecessary procedures on patients.
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Among the allegations:
- Patients were implanted with a sacral nerve stimulator without proper evaluation
- Numerous cystocopy and retrograde pyelogram procedures were performed unnecessarily
- Electromyography tests were conducted on nearly every new patient, despite being rarely used in urology
- Thousands of unnecessary ultrasound tests were ordered
Investigators also allege the practice billed for a more complex procedure known as Direct Visual Internal Urethrotomy, even when a simpler procedure was performed instead.
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Federal officials say that resulted in higher reimbursements than the practice was entitled to receive.
“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.
As part of the settlement, the whistleblowers will receive nearly $2.95 million. Officials say the settlement resolves allegations only, and there has been no determination of liability.