By Forum Staff
State Attorney General Tish James, Georgia Attorney General Christopher Carr, and New Jersey Attorney General Matthew Platkin on Tuesday filed a complaint against Fresenius Vascular Care, Inc. (FVC), one of its New York-based executives, Gregg Miller, M.D., and several of their affiliates for subjecting Medicaid recipients with end-stage renal disease (ESRD) to unnecessary surgeries and defrauding the New York state Medicaid program. The defendants allegedly scheduled ESRD patients for appointments every three to four months purportedly to preserve their dialysis access sites. At these appointments, the defendants sedated the patients and performed invasive procedures on their veins and arteries, putting already vulnerable patients at a heightened risk of grave complications. In reality, most of these patients had no problems receiving dialysis and did not need these surgeries. Moreover, FVC’s parent company’s own research showed that the so-called “monitoring” surgeries they performed do not benefit ESRD patients and in fact can damage their ability to receive life-saving dialysis treatment.
Tuesday’s complaint, jointly filed in federal court in Brooklyn with the attorneys general of Georgia and New Jersey, alleges that FVC knowingly subjected ESRD patients — including elderly people, people of color, and low-income individuals — to unnecessary and invasive procedures to increase its revenues. As alleged in the complaint, “Medical Directors were trained on the FVC philosophy: ‘simply increase revenue and decrease expense.’” FVC allegedly falsified patient referrals, ignored relevant medical records, and falsified diagnostic reports to justify billing for repeated diagnostic and surgical procedures. These procedures included fistulagrams, which are radiological procedures in which dye is injected into the patient’s vein or artery to visualize the port and surrounding blood vessels, and angioplasties, in which wires and balloons are inserted into veins or arteries that have narrowed to restore the patient’s blood flow.
As alleged in the complaint, due to FVC’s scheme, a 41-year-old ESRD patient in New York underwent at least 27 unnecessary angioplasties from December 2012 to May 2018 at a Fresenius Vascular Access Center in the Bronx and an 80-year-old ESRD patient in Brooklyn underwent at least 15 unnecessary angioplasties during the same time period.
The complaint further alleges that FVC knowingly operated a scheme to trap patients in a cycle of “clinically timed evaluations” that subjected them to these procedures every three to four months. The procedures carried grave risks such as over-sedation, infection, ruptured blood vessels, and internal or external bleeding. The complaint alleges that FVC pressured its providers to adopt this scheme, by creating contests to incentivize its staff to maximize the number of procedures done on dialysis patients and pushing doctors who questioned the scheme to quit. At one point, Dr. Miller allegedly told a physician who questioned whether the repeated procedures were necessary, “How can you expect to make money if you are sending 80 percent of the patients home?”
This lawsuit, which seeks damages and penalties under the New York False Claims Act and other state laws, is the result of a joint investigation with the U.S. Attorney’s Office for the Eastern District of New York and the National Association of Medicaid Fraud Control Units. The case was initiated by two doctors, who are pursuing claims on behalf of 16 additional states pursuant to those states’ false claims acts. The lawsuit was filed under the qui tam provisions of the federal and state false claims acts, which allow average citizens to file civil actions on behalf of the government and to share in the proceeds of any recovered funds.
- Psilocybin mushrooms
- Three scales containing cocaine residue
- A Smith and Wesson .45mm pistol with six rounds of ammunition
- A Taurus .9mm pistol with a large capacity ammunition-feeding device containing 22 rounds
- A Taurus 410G revolver with five rounds of ammunition
- A Zastava .223mm assault rifle with five rounds of ammunition
- $1,052 in cash
- Six kilo presses
At the time of the raid, 10-year-old boy was asleep in the bedroom he shared with his parents, Lewis and Jackson.
“Where there are drugs and guns, there is addiction, violence and death,” Katz said. “We cannot, and will not, relent in the war against lethal illegal drugs and weapons and will hold accountable drug traffickers threatening the safety of communities.”
If convicted, each defendant faces up to 30 years in prison.
