Aarti D. Pandya, M.D. and Aarti D. Pandya, M.D. P.C. (“Pandya Practice Group”) have 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. This settlement resolves allegations that from January 1, 2011 to December 31, 2016, Pandya knowingly submitted false claims to federal healthcare programs for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies. 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.
This 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 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.
To protect federal healthcare programs and beneficiaries going forward, Pandya and the Pandya Practice Group have entered into a detailed, multi-year Integrity Agreement and Conditional Exclusion Release (IA) with OIG that is more robust than OIG’s standard agreement. The IA includes training and reporting requirements and enhanced material breach provisions. The IA also requires that Pandya and the Pandya Practice Group hire an Independent Review Organization to conduct annual claims reviews to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claims were correctly coded, submitted, and reimbursed. OIG did not release its permissive exclusion authority and will provide such a release only after Pandya and the Pandya Practice Group have satisfied their obligations under the IA.
