The government’s complaint alleges that Dr. Pandya engaged in multiple schemes to submit false claims to Medicare, including claims for medically unnecessary cataract extraction surgery. Cataract surgery is only justified when a patient has a cataract that advances to the point where the patient cannot see well enough to carry out their normal daily activities. In many cases, Dr. Pandya performed surgery despite the fact that her patients had little to no vision complaints and normal visual acuity. She also failed to determine whether the patient would benefit from less invasive measures, such as glasses, as is required before submitting Medicare claims for cataract surgery.
The complaint also says Dr. Pandya rendered false glaucoma diagnoses, which she used to submit a battery medically unnecessary diagnostic tests to Medicare. These diagnostic tests were often incomplete, of extremely poor quality, and not used by Dr. Pandya in treating the patients. For a period of time, one of the machines that Dr. Pandya used for diagnostic testing was not functioning, but she continued to bill Medicare for these tests, which were never performed.
The complaint also alleges that the Pandya Defendants submitted large numbers of false claims for office visits, commonly referred to as evaluation and management services. The Pandya Defendants billed Medicare for high level office visits nearly every time patients visited the clinic. Dr. Pandya, however, spent very little time with her patients and failed to provide the services required of these high level office visits. The Pandya Defendants also filed false claims for office visits when patients came to the clinic for care associated with procedures for which Medicare was already paying.
The lawsuit was filed by whistleblower Laura Dildine, a former office manager for the Pandya Defendants, under the qui tam, or whistleblower, provisions of the False Claims Act. Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. The act permits the government to intervene in such lawsuits, as it has done in this case. Defendants found liable under the act are subject to treble damages and penalties.