A cardiologist with a history of False Claims Act settlements says the federal government is abusing the whistleblower process.
Wichita, Kansas cardiologist Joseph P. Galichia, MD, has a beef with the Department of Justice.
Galichia – who last week paid $5.8 million after negotiating his third False Claims Act settlement in 20 years – says the federal government is abusing the whistleblower process, and using it to take back money that was rightfully earned by physicians and hospitals.
"Unfortunately, the federal government has chosen to solve its financial problems with Medicare by pursuing physicians, hospitals, and other healthcare providers to seek reimbursement of money paid for legitimate patient care," Galichia says in a media release this week.
He's asking Congress to investigate "the DOJ's flawed probe, according to board certified experts based on a whistleblower's civil action, and the effect that questionable legal precedents are having on cardiologists nationwide."
"This national trend of accusing providers seriously interferes with the patient-physician relationship and leaves many patients without the care they need because physicians and other providers are intimidated by the risk of a fraud allegation by the federal government," he says.
DOJ said in a media release last week that Galichia improperly billing federal healthcare programs for medically unnecessary balloon angioplasties from 2008 through 2014.
The settlement stems from a whistleblower lawsuit filed by Aly Gadalla, MD, that the federal government joined in 2014. Gadalla will get $1.16 million from the settlement, DOJ said.
"Performing medically unnecessary procedures puts patients at risk and defrauds federal health care programs," said Stephen McAllister, U.S. Attorney for the District of Kansas.
Despite the settlement, Galichia "firmly denies" the allegations, and referred to Gadalla as "a disgruntled former employee who started the entire action and is not even a cardiologist."
Galichia claims he settled "only because, after seven years of cooperating with the investigation, the action was taking up far too much time and energy."
"Further, it simply became too costly to keep defending against these false accusations," he said. "The federal government decides, after the fact, what care the patient should have received, second-guessing the physician and the patient regardless of the health or satisfaction of the patient."
Galichia says his patients weren't in danger because they got the correct care, a claim that he says is supported by "expert interventional cardiologists" who reviewed the government's 100 cases against him and "unanimously agreed that our treatment was appropriate."
The former two-term president of the International Society of Cardiovascular Interventionists settled claims alleging improper documentation in 2000, and again in 2009, agreeing to pay the federal government $1.5 million and $1.3 million, respectively, to resolve the allegations.
Galichia's attorney, Gary Ayers, said "disgruntled whistleblowers and their lawyers" are incentivized to make "false allegations" with the hope of cashing in on a big settlement.
"The government pays a physician 'expert' to second-guess another physician's medical judgment, then alleges this supposed disagreement over treatment is fraud," Ayers said. "In Dr. Galichia's case, the government's 'expert opinion' was absolutely wrong according to four independent, board-certified interventional cardiologists who reviewed the same cases."
Ayers said that "hundreds if not thousands of providers across the country have experienced this same phenomenon."
"Congress needs to reign in the federal government's overreaching and abusive behavior, because it puts patients at risk of not receiving the medical care they need and deserve," Ayers said.
“The federal government decides, after the fact, what care the patient should have received, second-guessing the physician and the patient regardless of the health or satisfaction of the patient.”
Joseph Galichia, MD
John Commins is a senior editor at HealthLeaders.
Joseph Galichia, MD, wants Congress to investigate the DOJ's 'flawed' whistleblower process 'and the effect that questionable legal precedents are having on cardiologists nationwide.'
Galichia's attorney, Gary Ayers, said 'disgruntled whistleblowers and their lawyers' are incentivized to make 'false allegations' with the hope of cashing in on a big settlement.