A Lehigh Valley-area surgeon, Dr. Maneesh Ailawadi, has consented to pay a settlement of $45,000 plus interest to address allegations asserted under the False Claims Act. This settlement follows claims that Ailawadi caused false billing for esophagogastroduodenoscopies (EGDs) on bariatric patients at the now-shuttered Steward Easton Hospital, according to the U.S. Attorney's Office.
EGDs, a diagnostic procedure to examine the esophagus, stomach, and duodenum, can often unveil problems hiding in the depths of a patient's digestive tract. Between January 1, 2019, to March 31, 2020, Dr. Ailawadi reportedly billed for complete EGDs under CPT Code 43239, but allegedly chose to not fully perform these examinations by skipping the duodenum—a critical part of the process. U.S. Attorney Jacqueline C. Romero highlighted the commitment to "hold accountable those who bill the Federal Healthcare Programs for procedures that are either not performed, or partially performed," in a statement obtained by the U.S. Attorney's Office.
The government contends that Dr. Ailawadi’s approach amounted to time-saving measures — a complete EGD was not always undertaken, yet claims were submitted to federal healthcare programs as if they were, seemingly demonstrating an indifference to the diagnostic importance of the procedure and the fiscal trust placed in healthcare providers. The issue of trust and reliance on the integrity of those in the practice of medicine cannot be underplayed as the integrity of Federal Healthcare Programs like Medicaid and Medicare are of paramount concern, as invoked by Special Agent in Charge Maureen R. Dixon.
The settlement not only seeks to recover funds thought to have been improperly billed but also serves as a warning to those in the healthcare sector about the repercussions of fraudulent actions. These allegations originated from a lawsuit filed by a former employee of Steward Easton Hospital under the whistleblower provisions of the False Claims Act. "Today's settlement shows our attention to and commitment to investigating allegations of fraud targeting Medicare and Medicaid," said Dixon in a quote widely circulated by the U.S. Attorney's Office.
The recovered $45,000 will be returned to the federal healthcare program, but the settlement does not imply an admission of liability, and the allegations remain unproven. The case illustrates the complexities of alleged actions, their potential consequences, and the pursuit of justice within the legal framework. This matter was managed by Assistant U.S. Attorneys Deborah W. Frey and Eric D. Gill, along with others from the U.S. Attorney’s Office for the Eastern District of Pennsylvania, in collaboration with the U.S. Department of Health and Human Services Office of Inspector General.
