Aarti Pandya, MD, is an eye doctor. Even though they can both prescribe eyeglasses and do eye exams, they are fully qualified medical professionals.
An ophthalmologist is a medical specialist who treats eye diseases, performs eye surgery, and even does research. The vast majority of these doctors are perpetual students, always expanding their knowledge of a narrow area of medicine, whether it be the cornea or the retina.
Pandya Practice Group’s medical director, Dr. Aarti Pandya, promises to provide state-of-the-art surgical and pharmaceutical solutions for common eye problems such as dry eye, glaucoma, cataracts, AMD, and refractive errors.
However, she has been the subject of numerous allegations of wrongdoing and patient manipulation.
Dr. Aarti Pandya Pays $1 Million to Resolve False Claims Act Case
After being accused of billing the government for unnecessary cataract surgeries, unnecessary diagnostic tests, unnecessary appointments, and appointments that didn’t provide the level of service promised, she has agreed to pay about $1,850,000 to settle False Claims Act violations.
Attorney General of the United States Ryan K. Buchanan said, “Physicians who perform procedures and tests without a valid medical need prioritize profits over patients and expose those in need to needless risk.” The agreement states, “Our office is committed to enforcing responsibility for physicians who expose people to unnecessary medical care and waste taxpayer funds.”
As the head of the FBI in Atlanta, Keri Farley, said, “We must reassure consumers and taxpayers that medical needs, not fiscal greed, determine healthcare.” The FBI said in a statement that the settlement “should serve as a reminder that the FBI will not tolerate healthcare providers who engage in schemes that defraud the industry and endanger honest patients.”
Special Agent in Charge Tamala E. says that when coordinating care for recipients, it is very important to examine the medical appropriateness of the services clients require to safeguard their health. Bad medical care is when patients are subjected to unneeded procedures to milk the healthcare system for all its worth. Investigating potential threats to patient safety and the federal healthcare system’s integrity is a top priority for the HHS-OIG and our judicial partners.
Darrin K. Jones, Special Agent in Charge of the Southeast Field Office of the Defense Criminal Investigative Service (DCIS), said, “We are committed to fully investigating those who fraudulently bill the Department of Defense (DoD) health care system for their financial gain at the expense of service members and their families.” The U.S. Attorney’s Office and our investigative partners have proven a strong dedication to protecting America’s military personnel.
Other false claims:
Dr. Aarti Pandya allegedly submitted false claims to federal healthcare programs for YAG laser capsulotomies and medically unnecessary cataract extractions between January 1, 2011, and December 31, 2016.
The authorities claimed that Dr. Aarti Pandya had given these therapies to individuals who weren’t candidates for them and that in some cases, she had even caused harm to them. The agency also alleged that Pandya diagnosed patients with glaucoma when there wasn’t any, billing Medicare for unnecessary tests and treatments.
The government claims that several of the diagnostic tests requested by Pandya were either not performed properly, were performed on broken equipment, or were not interpreted in the patient’s medical file as Medicare mandates.
This settlement resolves claims made in a complaint lodged by former Pandya Practice Group employee Laura Dildine in compliance with the FCA’s qui tam, or whistleblower, processes. Individuals can file false claims lawsuits on behalf of the government and share in the settlement money thanks to the False Claims Act. The case is titled United States ex rel. Dildine v. Aarti D. Pandya, M.D. et al. and is pending in the Northern District of Georgia. The case number is 1:13-CV-3336-LMM. The United States joined this suit as a participant in 2018.
HHS argues that Medicare payments for Part B claims filed by the Pandya Practice Group were withheld due to government interference in the qui tam litigation. The freeze on payments went into effect on October 23, 2019.
Dr. Aarti Pandya and the Pandya Practice Group attempted to appeal the district court’s decision to temporarily halt payments but were ultimately unsuccessful. As part of the settlement of the government’s claims in this case, the Pandya Practice Group agreed to forfeit the suspended money to the government. The payment freeze will be lifted per the terms of the agreement.
To protect federal health care programs and beneficiaries, OIG has contracted with Dr. Aarti Pandya and the Pandya Practice Group under a thorough, multi-year Integrity arrangement and Conditional Exclusion Release (IA) that is stricter than OIG’s standard arrangement. The IA includes new training and reporting requirements in addition to harsher sanctions for serious violations.
Medical necessity, correct documentation, proper coding, submission, and reimbursement of the products and services given are all checked annually by an Independent Review Organization on behalf of Aarti Pandya and the Pandya Practice Group per the terms of the IA. OIG has not and will not release its permissive exclusion authority unless Aarti Pandya and the Pandya Practice Group meet the conditions set forth by the IA.
Dr. Aarti Pandya, MD, and the Pandya Practice Group were the targets of an investigation and subsequent legal action conducted by Assistant US Attorneys David A. O’Neal, Austin M. Hall, and Akash Desai. Regarding the claims that the deal is meant to settle, no liability has been determined; there have just been accusations.
Conclusion
The Independent Review Organization (IRO) is responsible for selecting a representative sample (the “Claims Review Samples”) consisting of 100 Medicare-paid claims and 100 managed care Medicare-paid claims.
To determine whether the goods and services provided were legally required and properly documented and whether the claim was properly coded, uploaded, and refunded, the IRO must review the Paid Claims in light of Dr. Aarti Pandya’s documentation and the requirements of the applicable Medicare and Medicare-handled care programs.
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