BAY CITY - A vascular surgeon from Bay City, Michigan pleaded guilty today to participating in a scheme to defraud Medicare, Medicaid, and Blue Cross/Blue Shield out of approximately $19.5 million, announced United States Attorney Dawn N. Ison.
Ison was joined in the announcement by Acting Special Agent in Charge Joshua Hauxhurst of the FBI’s Detroit Division and Special Agent in Charge Mario Pinto of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office.
Pleading guilty was Dr. Vasso Godiali, 59.
According to the plea agreement, Godiali began knowingly defrauding the three medical insurers in approximately 2009 and did so by causing the submission of false billing to all three insurers. As evidenced in the plea agreement, Godiali’s false and fraudulent billing includes admissions related to claims for the placement of stents in dialysis patients and for the treatment of arterial blood clots. Godiali admitted that he billed for the placement of multiple stents in the same vessel, and prepared medical records purporting to document the medical necessity justifying that billing. In fact, Godiali did not place those stents, and he admitted to billing the insurers for services never rendered while preparing materially inaccurate medical records to justify the fraudulent billing. With respect to arterial blood clots, the plea agreement documents a similar pattern of misconduct. Godiali acknowledged that his medical records would describe encountering occluded arteries that would appear to justify the performance of arterial thrombectomies. In fact, as Godiali admitted that he often encountered no such occlusions, performed no such thrombectomies, and thus billed insurers for services never rendered while preparing false medical records to justify the fraudulent claims.
“The scale of Dr. Godiali’s fraud is stunning and his willingness to illegally enrich himself at the expense of our district’s taxpayers and policyholders is egregious.” said U.S. Attorney Ison. “Brazen schemes like this have no place in our district, and today’s guilty plea reflects my office’s commitment to holding medical providers accountable when they abuse society’s trust by engaging in such misconduct.”
“When Dr. Godiali submitted claims for medical services that were never provided, he violated the trust of his patients and defrauded taxpayer-funded health care programs,” said Special Agent in Charge Mario M. Pinto. "HHS-OIG agents will continue to work with our law enforcement partners to identify and investigate medical providers who prey on beneficiaries and steal from federal health care programs."
“Today’s guilty plea should send a clear message to all health care providers that health care fraud is a federal crime that carries serious consequences and will not be tolerated,” said Josh P. Hauxhurst, Acting Special Agent in Charge of the FBI in Michigan. “In partnership with federal, state, and private sector partners, the FBI will work diligently to identify these fraud schemes and hold parties who execute them accountable.”
Sentencing is set for September 15, 2022. Godiali faces up to ten years’ imprisonment and the forfeiture of $19.5 million. Under the terms of the plea agreement, Godiali will be required to pay $19.5 in restitution to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. A civil forfeiture case against approximately $39.9 million seized from accounts controlled by Godiali remains pending.
The case was investigated by Special Agents of the HHS and FBI, with cooperation and assistance from the Michigan Attorney General’s Office, Michigan Department of Health and Human Services - Office of Inspector General.
The case is being prosecuted by Assistant U.S. Attorneys John K. Neal, Philip A. Ross, and Craig F. Wininger with assistance from the Michigan Attorney General’s Health Care Fraud Division.
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