Radiology group paying $8.8M over False Claims Act violations

Photo: Svenja Foto/Getty Images

National Interventional Radiology Partners, based out of Houston, and its founder and CEO have agreed to pay $8.8 million to resolve Federal False Claims Act (FCA) and Anti-Kickback Statute violation allegations, according to the U.S. Attorney's Office of the Southern District of Texas.

The settlement claims NIRP and Dr. Andrew Gomes, 48, illegally paid physicians for referrals to clinics established to surgically treat patients with Peripheral Arterial Disease (PAD), a circulatory disease that causes plaque build-up in the arteries. It most commonly affects the lower legs of elderly individuals.

WHAT'S THE IMPACT

Beginning in 2015, Gomes established a number of clinics throughout Texas under the NIRP umbrella to surgically treat PAD, according to the AG's office. Gomes raised capital for these clinics from physicians who had medical practices that would provide a strong patient base for Medicare referrals, including primary care physicians, doctors of podiatric medicine and family practitioners.

Gomes' pitch to the investor physicians, the AG said, was that they could ensure high returns on their investment in each surgical center from referring significant numbers of patients for treatment. Gomes allegedly told the investing physicians that more patient referrals would lead to more revascularization surgeries and higher profits – which funnels back to the investing physicians as monthly dividends.

Gomes also told the physicians that once the surgical centers were up, running and profitable, they could be sold, which would create additional value for investors. 

Surgeries such as arteriograms, angiograms, angioplasties and atherectomies that revascularize the lower limbs of patients with PAD are highly compensated procedures, the AG said.

The settlement resolves claims brought under the qui tam, or whistleblower provisions of the FCA. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of the recovery. In this instance, the whistleblower filed his complaint in late 2018, which triggered the investigation; he will receive 19% of the recovery, or about $1.6 million.

THE LARGER TREND

Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023, and, of that total, more than $1.8 billion related to matters that involved the healthcare industry – including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians, according to the U.S. Department of Justice.

The DOJ said the government and whistleblowers were party to 543 settlements and judgments, the highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $75 billion.

Overall, healthcare fraud was responsible for two-thirds of the recovered amount in 2023.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.