Report on Medicare Compliance 31, no. 14 (April 18, 2022)

◆ Michigan gynecologic oncologist Vinay Malviya, M.D., has agreed to pay $775,000 to settle false claims allegations in connection with medically unnecessary surgeries, the Department of Justice (DOJ) said April 14.^[1] The settlement resolves allegations that Malviya submitted false claims to federal health care programs from Feb. 1, 2011, through June 30, 2017, related to “(1) radical hysterectomies and modified radical hysterectomies that Dr. Malviya performed when only simple hysterectomies were medically necessary; (2) chemotherapy services that Dr. Malviya administered or ordered that were in excess of what was medically necessary; and (3) evaluation and management services by Dr. Malviya that were not performed or not rendered as represented,” the U.S. attorney’s office said. In August, Ascension Michigan and related hospitals, Providence Park Hospital, St. John Hospital and Medical Center, St. John Macomb Oakland Hospital and Ascension Crittenton Hospital (collectively, Ascension Michigan), agreed to pay $2.8 million to settle false claims allegations stemming from claims they submitted for medically unnecessary procedures performed by Malviya, DOJ said.^[2] The false claims case against the physician and the hospitals, which didn’t admit liability in the settlements, were set in motion by whistleblowers.

◆ The HHS Office of Inspector General has updated its work plan, and new items include an audit of the electronic visit verification system for Medicaid in-home visits.^[3]

1 Department of Justice, “Michigan Doctor to Pay $775,000 to Resolve False Claims Act Allegations,” news release, April 14, 2022, https://bit.ly/3M98d0o.
2 Department of Justice, “Ascension Michigan to Pay $2.8 Million to Resolve False Claims Act Allegations,” news release, August 5, 2021, https://bit.ly/3fzu7fl.
3 “Recently Added,” Work Plan, OIG, accessed April 15, 2022, https://bit.ly/2AxFtyP.

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