Advanced Urology to pay $14mn over alleged false billing and unnecessary procedures

A major healthcare fraud case in Atlanta has been resolved, with Dr Jitesh Patel, Advanced Urology, Inc, and its affiliated entities agreeing to pay $14 million to settle allegations of violating federal and state laws. 

The case involves claims that the group billed government healthcare programs such as Medicare and Medicaid for procedures that were either not performed or were medically unnecessary, in violation of the False Claims Act and the Georgia False Medicaid Claims Act.

The alleged misconduct included performing unnecessary urological and diagnostic procedures and inflating bills to maximize revenue. Officials emphasised that such actions not only misuse taxpayer-funded programs but also put patients at risk. US Attorney Theodore S Hertzberg stated that billing for unperformed or unnecessary services constitutes fraud and will not be tolerated. 

Several agencies, including the Department of Health and Human Services Office of Inspector General, the FBI, and the Department of Veterans Affairs, reiterated their commitment to cracking down on healthcare fraud and protecting public funds, as per reports.

The investigation began after whistleblower complaints filed by a former employee and a former physician at Advanced Urology. They alleged that the organisation routinely carried out unnecessary procedures, including implanting sacral nerve stimulators without proper evaluation, conducting excessive cystoscopy and retrograde pyelogram procedures, and ordering large numbers of unwarranted ultrasound tests. 

It was also claimed that nearly all new patients underwent electromyography tests despite limited relevance in urology. Additionally, the practice allegedly billed for a more complex procedure known as Direct Visual Internal Urethrotomy (DVIU) while performing a simpler treatment to receive higher reimbursements.

The case was brought under the whistleblower, or ‘qui tam,’ provisions of the False Claims Act, which allow private individuals to sue on behalf of the government. As part of the settlement, the whistleblowers will receive approximately $2.94 million. The matter resolves two lawsuits filed in the US District Court for the Northern District of Georgia.

Authorities clarified that the settlement addresses allegations only, and no formal determination of liability has been made. The case was investigated by multiple federal and state agencies, with prosecutors highlighting the importance of holding healthcare providers accountable and safeguarding the integrity of public healthcare systems.