NEW YORK – New York Attorney General Letitia James, Georgia Attorney General Christopher Carr, and New Jersey Attorney General Matthew Platkinfiled 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.
“Patients should be able to trust that their wellbeing will be the top priority for the health care providers they visit,” saidAttorney General James. “Our complaint alleges that Fresenius Vascular Care not only spent years endangering vulnerable patients with unnecessary invasive surgeries, they used those procedures to defraud taxpayer-funded programs that provide health care for low-income and elderly Americans. Today we’re taking action to stop these abusive practices and ensure New Yorkers can trust that they will be properly cared for when they walk into a doctor’s office.”
Today’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% 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 thequi tamprovisions 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.
The case is being handled by the Medicaid Fraud Control Unit (MFCU) including Special Assistant Attorneys General Logan J. Gowdicott and Jill D. Brenner under the supervision of MFCU Civil Enforcement Division Chief Alee N. Scott. The case was investigated by Principal Auditor-Investigator Karin Flynn under the supervision of Regional Chief Auditor Stacey Millis, Detective Stanislav Tabakov under the supervision of Detective Supervisor Dominic DiGennaro, Acting Executive Officer Ronald Lynch, and Commanding Officer Chief William Falk, and Legal Assistant Alexandra Schmidt. The MFCU is part of the Division of Criminal Justice and is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division of Criminal Justice is led by Chief Deputy Attorney General José Maldonado and overseen by First Deputy Attorney General Jennifer Levy.
The MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.
Reporting Medicaid Provider Fraud: MFCU defends the public by addressing Medicaid provider fraud and protecting nursing home residents from abuse and neglect. If an individual believes they have information about Medicaid provider fraud or about an incident of abuse or neglect of a nursing home resident, they can file a confidential complaint online or call the MFCU hotline at (800) 771-7755. If the situation is an emergency, please call 911.
