A cardiologist practicing in Kansas has recently decided to settle medical billing fraud allegations against him that he had fought for seven years. According to a May 30, 2018 article posted on the Wichita Eagle’s website, Joseph Galachia, MD claims innocence with regard to the fraud accusations brought against him by the U.S. Department of Justice.

With the agreement to pay $5.8 million, Galachia provided a written testament to his claim of innocence. He stated that he was done with the ongoing expense and time involved in fighting the lawsuit. As indicated by the report, the medical billing fraud case was first registered in federal court in late July 2012. The public has been unable to view any aspect of the record until recently.

The whistleblower case accused the well-known heart specialist of performing unnecessary medical procedures and billing public health programs like Medicare and Medicaid for the cost.

In a news release posted on the U.S. Department of Justice (DOJ) site also on May 30, 2019, the DOJ noted that this was not the first False Claim Act (FCA) settlement reached with Galachia. The physician was accused first in 2009 of submitting claims for services and procedures that either were not actually done or were not properly documented.

Even further back, Galachia purportedly marked up his claims for the next tier of service complication, double billed, or billed for services never done. In both cases, the doctor and his practice—Galachia Medical Group, P.A.—settled for $1.3 million and $1.5 million, respectively.

This latest suit contended that for the six years between January 2008 and December 2014, Galachia and his medical group engaged in medical billing fraud for cardiac stent procedures by submitting claims to the Federal Employees Health Benefits Program, Medicare, and the Defense Health Agency. The procedures were completed but not allegedly not medically necessary.

What is a Heart Stent?

According to the American Heart Association, a cardiac stent is a balloon-tipped catheter covered with a tiny wire mesh tube. Ordinarily delivered via angioplasty, the catheter is used to widen the diameter of a blood artery feeding the heart muscle narrowed by plaque.

Once in place, the balloon is inflated to open up the compromised artery to allow for greater blood flow. Upon inflation, the stent expands and locks into place to form a type of scaffolding to keep the vessel open. Sometimes, balloon angioplasty is done without a stent, but reoccurrence of the narrowing can happen in some of these cases.

The Whistleblower Case

This most recent whistleblower case against Galachia was originally filed by Aly Gadalla, MD, who will share in a portion of the recovered funds gained by this settlement. Gadalla, the relator, was empowered to file this complaint under the provisions of the False Claims Act. The Act allows private citizens to sue on behalf of their government, giving the government the option of picking up the case or negating to do so.

If it chooses to investigate and prosecute the case, monies retrieved are shared in part with the plaintiff—or relator—to reward them for protecting public interest. This provision of the false claim act is known as qui tam.

This article is not legal advice. It is presented
for informational purposes only.