How patients can avoid mistakes on medical bills
Well-known Wichita cardiologist Joseph Galichia has agreed to pay $5.8 million to settle a whistleblower lawsuit claiming he billed Medicare and other federal health care programs for heart stents and other medical procedures that patients didn’t need.
Galichia on Thursday denied the allegations in a written statement, saying he settled only because fighting the lawsuit was costly and a drain on his time and energy. It has dragged on for seven years already.
The False Claims Act settlement with the government is Galichia’s third. He and his medical group, Galichia Medical Group, in 2000 agreed to pay $1.5 million to end a lawsuit claiming they overbilled and double billed for services, or charged for medical procedures that were never done. Nine years later, Galichia and his group paid another $1.3 million for allegedly submitting claims for services that either were never provided or that lacked proper documentation.
Announcement of this latest — and largest — settlement came Thursday in a news release from the U.S. Department of Justice’s Civil Division. Although the case was filed in federal court years ago — on July 23, 2012 — it remained sealed to the public until earlier this week, according to court records.
Galichia, the lawsuit alleges, implanted dozens of “medically unnecessary and unreasonable” heart stents in at least 14 patients across Kansas from 2008 to 2014. He and his medical group then billed Medicare and other government health care programs for the costs.
One of his patients had as many as 35 cardiac stents surgically inserted, according to the lawsuit.
Three others had between 20 and 30 each.
One woman went to the Mayo Clinic after having “a number of … Galichia stents” inserted. She was told hers “were unnecessary” and was “advised to get another cardiologist,” according to a memorandum attached to the lawsuit containing information provided by the whistleblower.
A heart stent is a small, wire mesh device that opens coronary arteries narrowed by fatty buildup so blood flows freely, according to the American Heart Association. They help reduce the chance of a heart attack.
In all of the cases mentioned, Galichia and his medical group “knowingly and in reckless disregard of the truth” filed fraudulent claims for payment to Medicare, the Defense Health Agency and the Federal Employees Health Benefit Program, the lawsuit contends.
He received $10,000 to $11,000 for each stent placed, the lawsuit says.
“This settlement reflects the Department of Justice’s commitment to ensuring the safety of federal health care program beneficiaries and that taxpayer monies are properly spent,” Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division said in the news release.
“Patient safety is critically important. Performing medically unnecessary procedures puts patients at risk and defrauds federal health care programs,” U.S. Attorney Stephen McAllister said in the Department of Justice release.
Galichia has made an initial payment of $1 million and is scheduled to make payments through 2026, according to the Department of Justice.
Aly Gadalla, a doctor and former employee of Galichia’s, brought the lawsuit under the whistleblower provision of the False Claims Act. The provision allows individuals to sue on the government’s behalf in false claims cases and receive a portion of any money recovered. The government then can intervene and take over the lawsuit, if it chooses.
It did in this case on Dec. 12, 2014.
Gadalla will get a fifth of the settlement amount, about $1.16 million, the U.S. Department of Justice said.
According to a summary of Gadalla’s statements included in the memorandum attached to the lawsuit:
▪ The Kansas cardiology community was “well aware of Galichia’s unnecessary procedures” but that there weren’t problems with his internal medicine department so Gadalla agreed to work for Galichia.
▪ Gadalla learned that several of Galichia’s patients have 15 to 35 stents each and that Galichia receives “about $10,000-$11,000 for every stent he places.”
Galichia, the summary alleges, “was financially motivated to over stent” both because of his business ownership and because of surgeon fees.
▪ One nurse who helped Galichia made facetious remarks about how “Galichia must not have good vision because he sees things on (catheterization) films that others do not and are not there.” The film shows whether there is buildup in a patient’s heart arteries.
▪ Once, Galichia received a letter from the chairman of a hospital’s cardiology department questioning why Galichia put a stent in a patient that “did not need a stent.”
▪ Galichia once performed a heart catheterization on a 25-year-old “who did not require it” and performed other heart tests. He then sent the patient to another doctor to check for ulcers “after the patient’s money had been used up.”
▪ Only Galichia looks at patient films and he “alone determines” how much blockage is in a patient’s arteries and whether a stent is needed. “Dr. Galichia has people that make sure that the appropriate documentation is done in the chart for the Medicare audit, but these people never actually look at the catheterization film.”
▪ Galichia put stents in patients even when their blockages were not causing any symptoms or health issues, which “is not proper.”
▪ The patients on whom Galichia overuses stents “are normally poor patients.”
Galichia, in his written statement, said the lawsuit was brought by a disgruntled former employee and that the actions taken by the government were a “matter of legal bullying.”
“The Government enlisted first one, then another cardiologist, neither of whom were interventional cardiologists engaged in the full-time practice of cardiology. The Galichia Team, on the other hand, engaged four prominent cardiologists who each found that Dr. Galichia’s stent procedures were appropriate under American Heart Association/American College of Cardiology guidelines,” the statement reads.
It goes on to say that Galichia’s experts “each reviewed more than 200 cases” from 2008 to 2012, while the government initially only picked 12 patient cases to review.
Six patients interviewed by a retired FBI agent retained by Galichia told the agent that they thought their “stent intervention was necessary,” Galichia’s statement reads. The others either had died or their procedures weren’t attributed to Galichia, it says.
In addition to paying the multimillion dollar settlement, Galichia won’t be able to seek Medicare or other government health care program reimbursements for three years. Galichia’s statement says he agreed to exclude himself voluntarily “so long as the entities in which he is invested were not adversely impacted by his individual exclusion.”
His medical license remains active and he currently practices at 2600 N. Woodlawn, according to the Kansas Board Healing Arts. There are no license actions or settlement payments noted on his licensee and registrant profile.
Prepared statement from Galichia