Alleged Medicare Fraud: Fresenius Vascular Care Faces Civil Lawsuit for Unnecessary Surgeries

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According to a report from the office of the Attorney General and the Insurance Fraud Prosecutor, a civil complaint has been filed by New Jersey Attorney General Matthew J. Platkin along with New York Attorney General Letitia James and Georgia Attorney General Christopher Carr, against Fresenius Vascular Care (FVC).

The complaint targets FVC, one of its executives, Gregg Miller, MD, and several affiliates, accusing them of subjecting Medicare and Medicaid recipients with end-stage renal disease (ESRD) to unnecessary surgeries and defrauding federal health insurance programs.

“As alleged in this complaint, greed motivated these defendants to rip off taxpayers and subject sick patients with advanced kidney disease to needless, life-threatening medical procedures,” Platkin said in the statement.

The complaint alleges that the defendants scheduled patients with ESRD for appointments every 3 to 4 months under the pretext of preserving their dialysis access sites. During these appointments, patients were sedated, and invasive procedures were performed on their veins and arteries, putting their lives at risk.

Most of the patients did not require these surgeries; FVC’s own research reportedly showed these surgeries not only failed to benefit the patients with ESRD, but also potentially damaged their ability to receive essential dialysis treatment.

“Some of these patients were operated on repeatedly—for nothing. Conscientious medical professionals who raised questions and objections to this shameful scam and to the necessity of these surgeries faced backlash from the defendants,” Platkin stated. “This alleged fraud scheme not only resulted in waste and abuse of public finances but also was a violation of these health care providers’ duty to put their patients’ safety and health above all else.”

The lawsuit accuses the defendants of violating the New Jersey False Claims Act and state laws in New York and Georgia. According to the report, it was jointly filed by the 3 attorneys general on Monday, October 2, 2023, in federal court in Brooklyn, New York. Entities with New Jersey ties, including Image Guided Surgery & Aesthetics, Access Care Physicians of NJ, Azura Surgery Center, and New Jersey Interventional Associates, were named in the action.

FVC is accused of knowingly subjecting vulnerable patients with ESRD, including elderly individuals, people of color, and low-income individuals, to unnecessary and invasive procedures to boost their revenues.

The defendants allegedly manipulated referrals, disregarded relevant medical records, and falsified diagnostic reports to justify billing for repeated diagnostic and surgical procedures. Procedures such as fistulagrams and angioplasties, performed without medical necessity, put patients at severe risk, including over-sedation, infections, ruptured blood vessels, and bleeding, the report acknowledged.

This lawsuit is the outcome of a joint investigation involving the US Attorney’s Office for the Eastern District of New York and the National Association of Medicaid Fraud Control Units. A pair of doctors initiated the case on behalf of 16 additional states under the qui tam provisions of federal and state false claims acts. These provisions empower citizens to file civil actions on behalf of the government and share in recovered funds.

Deputy Attorney General Charisse Penalver is overseeing the case for the New Jersey Office of the Insurance Fraud Prosecutor – Medicaid Fraud Control Unit (OIFP-MFCU). The investigation, led by dedicated professionals including Civil Investigator Dalisha Carmichael, aims to hold the defendants accountable for their alleged fraudulent activities.

It was stated that New Jersey MFCU’s funding for FY 2023, totaling $9,418,641, demonstrates the state’s commitment to combating health care fraud and ensuring the protection of public resources.

Reference

AG Platkin sues Fresenius Vascular Care after vulnerable kidney dialysis patients are allegedly subjected to unnecessary surgeries in fraud scheme. Press Release. Office of the Attorney General Matthew J. Platkin, Office of the Insurance Fraud Prosecutor Al Garcia. October 4, 2023. Accessed October 5, 2023. https://www.njoag.gov/ag-platkin-sues-fresenius-vascular-care-after-vulnerable-kidney-dialysis-patients-are-allegedly-subjected-to-unnecessary-surgeries-in-fraud-scheme/