United States Attorney Jacqueline C. Romero announced that Maneesh Ailawadi, MD, has agreed to pay $45,000 plus interest to resolve False Claims Act allegations that he caused the submission of false claims by submitting inappropriate claims to Medicaid and Medicare by improperly billing esophagogastroduodenoscopies (EGDs) on bariatric patients at the former Steward Easton Hospital in Easton, Pennsylvania. Ailawadi, a bariatric and general surgeon, had privileges to perform bariatric surgeries and EGDs at Steward Easton Hospital. The government alleges that Ailawadi caused the submission of false claims for payment to both Medicaid and Medicare from January 1, 2019, to March 31, 2020, arising from Ailawadi improperly billing EGD procedures using CPT Code 43239 without reduced service modifier 52 when the duodenum was deliberately not examined. According to the United States, these EGD procedures were only partially completed to save time, although Ailawadi billed the federal healthcare programs as if they had been fully completed. By failing to enter the duodenum during the EGD procedure, Ailawadi allegedly was not able to identify any abnormalities, such as bleeding, growths, ulcers, or inflammation.
