A gynecologic oncologist, Vinay K. Malviya M.D., has agreed to pay $775,000 to resolve claims he violated the False Claims Act by submitting or causing the submission of false claims for payment to federal health care programs related to alleged medically unnecessary surgical procedures that he performed.
The settlement announced today resolves allegations that, from Feb. 1, 2011, through June 30, 2017, Dr. Malviya knowingly submitted false claims for payment to federal health care programs related to (1) radical hysterectomies and modified radical hysterectomies that Dr. Malviya performed when only simple hysterectomies were medically necessary; (2) chemotherapy services that Dr. Malviya administered or ordered that were in excess of what was medically necessary; and (3) evaluation and management services by Dr. Malviya that were not performed or not rendered as represented. In August 2021, Ascension Michigan and related hospitals agreed to pay $2.8 million to resolve claims that they violated the False Claims Act by submitting or causing the submission of false claims for payment to federal health care programs related to alleged medically unnecessary procedures performed by Dr. Malviya.
“Every day, patients rely on their doctors’ medical judgment to determine what type of medical care is reasonable and necessary,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to pursue doctors who knowingly abuse this trust and subject their patients to unnecessary treatments or procedures.”
“This settlement should put health care providers on notice that we will seek to hold those responsible who profit from providing services to patients that are more aggressive than medically necessary,” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “This office will use all available resources to protect the integrity of our nation’s health care systems.”
As part of the settlement, Dr. Malviya agreed to be excluded from Medicare, Medicaid and all other federal health care programs for a period of three years. During that time, federal health care programs will not pay anyone for items or services, including administrative and management services, furnished, ordered or prescribed by Dr. Malviya in any capacity.
“The submission of false claims for medically unnecessary procedures improperly diverts funds needed to care for the most vulnerable while increasing the financial burden on taxpayers,” said Special Agent in Charge Steven J. Ryan of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Along with our law enforcement partners, HHS-OIG will continue to investigate and hold accountable those who cause fraudulent claims to be submitted to federal health care programs.”
The civil settlement includes the resolution of claims brought by Pamela Satchwell, Dawn Kasdorf and Bethany Silva-Gomez under the qui tam or whistleblower provisions of the False Claims Act. Under these provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Satchwell v. Ascension Health, No. 17-CV-12315 (E.D. Mich.). Relators will receive a combined payment in the amount $147,250.
The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan, with assistance from HHS-OIG and the U.S. Defense Health Agency, Office of Program Integrity.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The matter was investigated by Trial Attorney Denise Barnes of the Civil Division’s Commercial Litigation Branch, Fraud Section and Assistant U.S. Attorney Carolyn Bell-Harbin of the U.S. Attorney’s Office for the Eastern District of Michigan.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.