PHILADELPHIA, PA — United States Attorney Jacqueline C. Romero this week announced a settlement agreement requiring Dr. Maneesh Ailawadi to pay $45,000 plus interest. This resolution addresses allegations that Dr. Ailawadi improperly billed Medicaid and Medicare for esophagogastroduodenoscopies (EGDs) performed on bariatric patients at the former Steward Easton Hospital in Easton, Pennsylvania.
Dr. Ailawadi, a bariatric and general surgeon with privileges at Steward Easton Hospital, faced accusations of submitting false claims for EGD procedures conducted between January 1, 2019, and March 31, 2020. The allegations centered on the misuse of Current Procedural Terminology (CPT) Code 43239, which was billed without the reduced service modifier 52, despite the procedures being partially completed. The government contended that by not examining the duodenum during these procedures, Dr. Ailawadi could not properly identify potential health issues such as bleeding, growths, or inflammation, yet billed as if the procedures were fully performed.
United States Attorney Romero emphasized the importance of accountability in healthcare billing practices, stating, “The United States Attorney’s Office for the Eastern District of Pennsylvania places a high priority on enforcement in cases involving healthcare fraud. We will hold accountable those who bill the Federal Healthcare Programs for procedures that are either not performed, or partially performed, as was the case here.”
Supporting this stance, Maureen R. Dixon, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General, highlighted the agency’s commitment to uncovering fraudulent activities. “Today’s settlement shows our attention to and commitment to investigating allegations of fraud targeting Medicare and Medicaid, whether we need to examine the potential conduct of an individual physician or several parties in a complex scheme,” Dixon remarked.
The settlement resolves a lawsuit initiated under the False Claims Act, filed in the U.S. District Court for the Eastern District of Pennsylvania by a former hospital employee. Under the qui tam provisions of the Act, whistleblowers can bring lawsuits on behalf of the government and share in any financial recovery. The relator in this case was represented by Brian J. McCormick, Jr., of Ross Feller Casey, LLP.
The investigation was conducted by the U.S. Attorney’s Office for the Eastern District of Pennsylvania, in partnership with the U.S. Department of Health and Human Services Office of Inspector General. Key figures in handling the investigation and settlement included Assistant U.S. Attorneys Deborah W. Frey and Eric D. Gill, along with Auditor George Niedzwicki, Fraud Examiner Frank O’Connor, and Paralegal Brendan Novak.
It is important to note that the settlement represents allegations only, with no determination of liability against Dr. Ailawadi.
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