Indian American ophthalmologist Aarti Pandya pays $1.85 million for needless tests, surgeries


An Indian American ophthalmologist has agreed to pay approximately $1.85 million for allegedly billing the government for cataract surgeries and diagnostic tests that were not medically required.

Aarti Pandya and her Pandya Practice Group violated the False Claims Act by also performing and billing for tests that were incomplete or of worthless value, and office visits that did not provide the level of service claimed.

“Physicians who perform procedures and tests without a legitimate medical need place profits ahead of patients and subject those patients to unnecessary risk,” said US Attorney Ryan K Buchanan in a statement released on Monday.

“This settlement represents our office’s commitment to ensuring accountability for physicians who subject patients to unwarranted medical care and waste taxpayer funds,” Buchanan said.

From January 1, 2011 to December 31, 2016, Pandya knowingly submitted false claims to federal healthcare programmes for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies, according to a Justice Department release.

The prosecution 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, it accused Pandya of falsely diagnosing patients with glaucoma to justify unnecessary diagnostic testing and treatment that was billed to Medicare.

The prosecution also said 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.

The Department of Health and Human Services (HHS) imposed in 2019 a payment suspension on the Pandya Practice Group that precluded it from receiving any reimbursement from Medicare for Part B claims.

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 health care 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.

“We must assure patients and taxpayers that healthcare is dictated by clinical needs, not fiscal greed,” said Keri Farley, Special Agent in Charge of FBI Atlanta. “This settlement should serve as a reminder that the FBI will not tolerate healthcare providers who engage in schemes that defraud the industry and put innocent patients at risk.”

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