Medicare Fraud Whistleblower Awarded $186,000 in Vascular Surgery Case

A group of South Florida medical providers has agreed to pay $810,000 to settle federal allegations that they fraudulently billed Medicare for medically unnecessary vascular procedures.  The settlement resolves a whistleblower lawsuit filed under the False Claims Act, with the whistleblower receiving nearly $186,000 for bringing the misconduct to light.

According to the U.S. Attorney for the Southern District of Florida, the defendants—Vascular and Interventional Specialists, LLC (VIS); Vascular and Spine Institute, Inc. (VSI); Dr. Oscar Sosa; and Dr. Osmany DeAngelo—submitted claims to Medicare for percutaneous transluminal angioplasties (PTAs) that were not medically necessary.  

PTAs are procedures intended to improve blood flow through narrowed or diseased blood vessels.  A catheter with a small balloon at its tip is inserted through the skin (percutaneously) into a blood vessel and guided to the site of the blockage.  The balloon is then inflated to compress the plaque or blockage against the vessel wall, thereby widening the vessel and restoring blood flow.

PTAs are considered “medically necessary” for purposes of Medicare reimbursement when performed for clinically significant stenosis or occlusion of the iliac, femoral, and popliteal arteries.  PTAs of the carotid artery are considered reasonable and necessary when performed with the placement of an FDA-approved carotid stent and an FDA-approved or cleared embolic protection device for patients with symptomatic carotid artery stenosis of 50% or greater.  PTAs and stenting are covered for the treatment of cerebral artery stenosis of 50% or greater in patients with recurrent symptoms despite medical therapy.

Federal prosecutors allege that from 2015 to 2024, the doctors and clinics in this case performed hundreds of these procedures without conducting any diagnostic inquiry or making clinical diagnoses to justify their use.

“These types of abuses not only defraud the Medicare program, they also subject patients to unnecessary and potentially risky medical procedures,” said a spokesperson for the U.S. Department of Justice.

The allegations came to light through a whistleblower lawsuit filed by Dr. Emilio Lopez, who brought the case under the False Claims Act’s qui tam provisions.  These provisions allow private individuals to file suit on behalf of the federal government and share in any recovery.  Dr. Lopez will receive approximately $186,000 from the settlement as his share of the government’s recovery.

The False Claims Act remains one of the federal government’s most powerful tools to combat fraud, particularly in the healthcare sector.  In fiscal year 2024 alone, settlements and judgments under the law exceeded $2.9 billion, with more than $2.4 billion coming from whistleblower-filed cases.  A record 979 qui tam lawsuits were filed during the same period.

If you have evidence that a health care provider is submitting claims to Medicare or Medicaid for procedures that are not medically necessary, you may be entitled to a financial reward and legal protections as a whistleblower.  Call John Howley, Esq. today at 212-601-2728 to schedule a free and confidential consultation with an experienced whistleblower lawyer.