ATLANTA (Diya TV) —- An Atlanta-area urology practice and its founder have agreed to pay $14 million to resolve federal allegations of widespread healthcare fraud, the U.S. Attorney’s Office for the Northern District of Georgia announced this week. Jitesh Patel, M.D., Advanced Urology, Inc., and affiliated companies will pay the settlement amount to resolve allegations that they violated the False Claims Act and the Georgia False Medicaid Claims Act by billing federal healthcare programs, including Medicare and Medicaid, for a series of urological and diagnostic procedures that were not performed or were medically unnecessary.
The government’s investigation began after a former Advanced Urology employee filed a whistleblower complaint alleging that Advanced Urology performed unnecessary procedures. A former Advanced Urology physician filed a second whistleblower complaint alleging that the practice billed government healthcare programs for procedures and tests that were not performed or were medically unnecessary.
The specific practices alleged are extensive and troubling. Whistleblowers alleged that Advanced Urology’s organization was designed to maximize revenue for Dr. Patel and others by performing medically unnecessary procedures and tests, including implanting permanent Sacral Nerve Stimulator devices in patients without first determining whether the patients would benefit from the device; performing numerous unnecessary Cystoscopy and Retrograde Pyelogram procedures, which involved placing a patient under anesthesia and inserting a small scope through the patient’s urethra and into the bladder; and performing an Electromyography test on almost every new patient at Advanced Urology, even though it is rarely used in urology practices. This test involved transmitting electrical signals through an electrode attached to the patient’s genitalia.
Whistleblowers also alleged the practice performed invasive tests on nearly every new patient and billed for surgeries that were never actually performed.
The settlement resolves two separate federal lawsuits. Under the False Claims Act, private citizens may bring suit for false claims on behalf of the United States and share in any recovery obtained by the government. The whistleblowers will collectively receive $2.94 million from the settlement. The cases also implicated TRICARE, the federal healthcare program serving military personnel and veterans.
Federal officials from multiple agencies responded forcefully to the settlement announcement. “Physicians commit fraud when they seek payment for medically unnecessary procedures or bill for services they never performed,” said U.S. Attorney Theodore S. Hertzberg. “Our office will not tolerate abuse of patients or misuse of government funds, and we will enforce the False Claims Act to hold wrongdoers accountable.”
“Allegations of upcoding and medically unnecessary procedures undermine the integrity of Medicare and other government programs,” said Special Agent in Charge Kelly Blackmon of the U.S. Department of Health and Human Services Office of Inspector General. “We will continue working closely with our law enforcement partners to ensure that providers who submit false claims are held accountable.”
“This settlement underscores the FBI’s commitment to investigating complex healthcare fraud schemes that prioritize profit over patient care,” said Peter Ellis, Acting Special Agent in Charge of FBI Georgia.
Georgia’s Deputy Attorney General Jim Mooney was equally direct: “Fraud against the Medicaid program is stealing from Georgia taxpayers, plain and simple. Performing unnecessary procedures takes limited resources away from those who truly need them. This office will ensure that Medicaid providers treat their patients and Georgia taxpayers with respect and not as a scheme to get rich.”
Dr. Patel had been regarded as a prominent figure in Atlanta’s medical community before the allegations surfaced. He has received awards including Atlanta Top Doc and Top 40 Under 40, studied medicine at Temple University, and had been praised in his field, making the allegations surprising to many.
It is important to note that this is a civil settlement, not a criminal conviction. Under the terms of the agreement, Dr. Patel and Advanced Urology have not admitted wrongdoing as part of the resolution. The settlement brings to a close years of litigation that began with whistleblower complaints first filed in 2018 and 2019 in the U.S. District Court for the Northern District of Georgia.
The case is part of a broader national effort by the Department of Justice to crack down on abuse of federal healthcare programs. Medicare and Medicaid fraud costs American taxpayers tens of billions of dollars annually, and the False Claims Act’s whistleblower provisions have become one of the government’s most effective tools for uncovering it.
