Medical Company Gave Patients ‘Unnecessary’ Surgeries, Sued: NJ AG

CHERRY HILL, NJ – New Jersey has joined two other states in suing a group of medical centers for allegedly subjecting Medicare and Medicaid recipients to unnecessary surgeries and defrauding both federal health insurance programs, Attorney General Matthew J. Platkin said.

New York, New Jersey and Georgia have filed a civil complaint against Fresenius Vascular Care (FVC), one of its New York-based executives, Dr. Gregg Miller, and several affiliates.

According to the suit, FVC scheduled end-stage renal disease (ESRD) patients for appointments every three to four months to preserve their dialysis access sites.

At these appointments, FVC sedated the patients and performed invasive procedures on their veins and arteries, putting vulnerable patients at a heightened risk of grave complications, the lawsuit said.

In reality, most of these patients had no problems receiving dialysis and did not need these surgeries, Platkin said.

Furthermore, FVC’s parent company’s own research showed that the “monitoring” surgeries they performed did not benefit ESRD patients and, in fact, can damage their ability to receive life-saving dialysis treatment, the suit said.

“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,” AG Platkin said in a statement.

“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 attorneys generals of New York, New Jersey and Georgia on Monday, in federal court in Brooklyn, New York.

The lawsuit also names several 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.

According to the lawsuit, FVC knowingly subjected patients including elderly people, people of color, and low-income individuals to unnecessary and invasive procedures to increase its revenues.

“Medical Directors were trained on the FVC philosophy: ‘simply increase revenue and decrease expense,’” the lawsuit said.

The medical group falsified patient referrals, ignored relevant medical records, and falsified diagnostic reports to justify billing for repeated diagnostic and surgical procedures, according to the suit.

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 suit 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.

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, the lawsuit said.

At one point, 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 percent of the patients home?” the lawsuit said.

One dialysis patient in New Jersey endured at least nine occasions of 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, the lawsuit said.

Some of the surgeries occurred just months apart, including three procedures performed on that same patient on March 15, July 9, and November 6, 2015, according to the lawsuit.

FVC knew that the services were neither reasonable nor medically necessary, but they performed them and submitted insurance claims for them anyway.

The lawsuit comes after 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, Platkin said.

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