TRENTON — Attorney General Matthew J. Platkin, New York Attorney General Letitia James, and Georgia Attorney General Christopher Carr today announced the filing of a civil complaint against Fresenius Vascular Care (FVC), one of its New York-based executives, Dr. Gregg Miller, and several affiliates, for allegedly subjecting Medicare and Medicaid recipients with end-stage renal disease (ESRD) to unnecessary surgeries and defrauding both federal health insurance programs.
According to the lawsuit, 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 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.
“As alleged in this complaint, greed motivated these defendants to rip off taxpayers and subject sick patients with advanced kidney disease to needless, life-threatening medical procedures,” said Attorney General Platkin. “Some of these patients were operated on repeatedly — for nothing. Conscientious medical professionals who raised questions and objections to this shameful scam and to the necessity of these surgeries faced backlash from the defendants. This alleged fraud scheme not only resulted in waste and abuse of public finances, but also was a violation of these healthcare providers’ duty to put their patients’ safety and health above all else.”
The complaint, accusing the defendants of violating the New Jersey False Claims Act as well as state laws in New York and Georgia, was jointly filed by the three attorneys general on Monday, October 2, 2023, in federal court in Brooklyn, New York.
The action names several entities with New Jersey ties, including Image Guided Surgery & Aesthetics on McBride Avenue in Woodland Park, Access Care Physicians of NJ on Galloping Hill Road in Union Township, Azura Surgery Center on Marlton Pike East in Cherry Hill, and the limited liability company New Jersey Interventional Associates, whose employees performed vascular-access services at the Fresenius Vascular Access Centers in New Jersey.
The complaint 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 blood flow.
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 staff to maximize the number of procedures performed 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?”
As alleged in the complaint, due to FVC’s scheme, one dialysis patient in New Jersey endured on at least nine occasions unnecessary X-rays and angioplasties between March 2013 and June 2018. In several instances, the patient was asked to come in for timed “clinical evaluations” without a referral and would then be operated on, with the defendants billing Medicare and New Jersey Medicaid for thousands of dollars with each procedure. Some of the surgeries allegedly occurred just months apart, including three procedures performed on that same patient on March 15, July 9, and November 6, 2015. The defendants allegedly knew that the services were neither reasonable nor medically necessary, but they performed them and submitted insurance claims for them anyway.
The lawsuit 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 the qui tam provisions 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.
Deputy Attorney General Charisse Penalver is handling the case for the New Jersey Office of the Insurance Fraud Prosecutor – Medicaid Fraud Control Unit (OIFP-MFCU) with the assistance of Civil Investigator Dalisha Carmichael under the supervision of Assistant Bureau Chief Michael Klein and Bureau Chief Heather Hadley, all under the direction of Interim Insurance Fraud Prosecutor Al Garcia. New Jersey MFCU’s total funding for federal fiscal year (FY) 2023 is $9,418,641. Of that total, 75 percent, or $7,063,984, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $2,354,657 for FY 2023, is funded by the State of New Jersey.
OIFP’s Medicaid Fraud Control Unit specifically protects Medicaid beneficiaries and the Medicaid Program from fraud, waste, and abuse. To report Medicaid Fraud, please email NJMFCU@njdcj.org or call 609-292-1272. Further, if you are concerned about insurance cheating and have information about a fraud, you can report fraud anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting www.NJInsurancefraud.org. State regulations permit a reward to be paid to eligible persons who provide information that leads to an arrest, prosecution, and conviction for insurance fraud.