- Aarti D. Pandya of Atlanta, Georgia, is accused of billing the government for cataract surgeries and diagnostic tests that were not medically necessary.
A Georgia doctor has agreed to pay approximately $1,850,000 to resolve allegations that her medical practice violated the False Claims Act by performing needless surgeries and tests on her patients. Ophthalmologist Aarti D. Pandya “billed the government for cataract surgeries and diagnostic tests that were not medically necessary, tests that were incomplete or of worthless value, and office visits that did not provide the level of service claimed,” according to the Department of Justice.
The allegations arose from a 2013 federal lawsuit filed by Laura Dildine, a former Pandya Practice Group office manager, under the whistleblower provisions of the False Claims Act. The act authorizes private parties to sue for false claims on behalf of the United States and share in the recovery. The lawsuit was filed in the Northern District of Georgia.
After the government intervened in the qui tam action, HHS imposed a payment suspension on the Pandya Practice Group that precluded it from receiving any reimbursement from Medicare for Part B claims. Pandya unsuccessfully challenged the payment suspension in district court. 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.
Pandya’s settlement also resolves allegations that from January 1, 2011, to December 2016, she knowingly submitted false claims to federal healthcare programs for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies. The government 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, the government alleged that Pandya falsely diagnosed patients with glaucoma to justify unnecessary diagnostic testing and treatment that was billed to Medicare. The government alleged 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.