Kansas Cardiologist and His Practice Pay $5.8 Million to Resolve Alleged False Billings for Unnecessary Cardiac Procedures
Joseph P. Galichia M.D., a Wichita, Kansas, cardiologist, has agreed to pay $5.8 million to resolve allegations that he and his medical group, Galichia Medical Group, P.A. (GMED), violated the False Claims Act by improperly billing federal health care programs for medically unnecessary cardiac stent procedures, the Department of Justice announced. Galichia also agreed to a three-year period of exclusion from participation in any federal health care program. The settlement relates to a lawsuit in which the United States intervened on Dec. 12, 2014.
“This settlement reflects the Department of Justice’s commitment to ensuring the safety of federal health care program beneficiaries and that taxpayer monies are properly spent,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division.
“Patient safety is critically important,” said U.S. Attorney Stephen McAllister for the District of Kansas. “Performing medically unnecessary procedures puts patients at risk and defrauds federal health care programs.”
“When a physician bills the government for medically unnecessary procedures, both patients’ health and taxpayers can end up paying the price,” said Special Agent in Charge Steve Hanson of the Office of Inspector General for the U.S. Department of Health and Human Services. “OIG is excluding Dr. Galichia from participation in Medicare, Medicaid, and other federal health care programs, and we will continue to work with our partners to protect the health and welfare of Medicare beneficiaries.”
The government contended that Galichia and GMED knowingly submitted false billings from Jan. 1, 2008, through Dec.31, 2014, for surgical procedures in which Galichia implanted coronary stents that were not medically necessary. The allegedly false billings were submitted to Medicare, the Defense Health Agency, and the Federal Employees Health Benefits Program.
This is the government’s third False Claims Act settlement with Galichia and GMED. In 2009, Galichia and GMED paid $1.3 million to settle allegations that they submitted claims for services not provided or lacking proper documentation. In 2000, Galichia and GMED paid $1.5 million to settle allegations that they submitted claims for a higher level of service than provided, billed twice for the same services, and billed for services not provided.
The settlement announced resolves allegations in a lawsuit filed by Aly Gadalla M.D., in the United States District Court for the District of Kansas. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did in this case. Dr. Gadalla will receive approximately $1.16 million.
The government’s 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 (HHS), at 800-HHS-TIPS (800-447-8477).
The investigation was conducted by the U.S. Attorney’s Office for the District of Kansas and the Department of Justice’s Civil Division, in conjunction with the HHS-OIG, the FBI, the Defense Health Agency on behalf of the TRICARE program, the Defense Criminal Investigative Service of the Inspector General for the Department of Defense, and the Office of Personnel Management, Office of Inspector General.
The case is captioned United States ex rel. Gadalla v. Dr. Joseph Galichia, et al., Case No. 12-1259 (D. Kan.). The claims resolved by the settlements are allegations only and there has been no determination of liability.