Month: May 2023

Source: United States Department of Justice 2

Vasso Godiali, a vascular surgeon from Bay City, Michigan, was sentenced on May 3 to 80 months in prison for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform and was ordered to pay $19.5 million in restitution collectively to Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan (BCBSM). Additionally, Godiali agreed to pay the United States up to $43,419,000 to resolve related civil allegations that his fraudulent billings to federal health care programs violated the False Claims Act (FCA).

According to a plea agreement that Godiali entered on Feb. 8, 2022, Godiali began to knowingly defraud medical insurers, including Medicare and Medicaid, in approximately 2009. Godiali billed for the placement of multiple vascular stents in the same blood vessel and prepared medical records purporting to document the medical necessity justifying that billing. In fact, however, Godiali did not place those stents and admitted to billing for services never rendered while preparing materially inaccurate medical records to justify the fraudulent billings.

Godiali also billed for arterial thrombectomies and created medical records that stated he encountered occluded arteries that would justify the performance of the procedures. However, he admitted that he often encountered no such occlusions, performed no such thrombectomies, and thus billed insurers for services never rendered while preparing false medical records to justify the fraudulent claims. Godiali’s fraudulent practices resulted in $14,473,000 in damages to the federal government, and a total of $19.5 million across Medicare, Medicaid, and BCBSM, which he agreed to repay as restitution as part of his plea agreement. 

In the related FCA action, in addition to alleging that Godiali submitted false claims for procedures that he never performed, the United States alleged that Godiali improperly used Modifier 59 to “unbundle” services that should have been billed together in a single claim to increase his reimbursements from federal health care programs.

A civil forfeiture case resulted in the seizure of approximately $39.9 million from financial accounts controlled by Godiali. Except for $7.5 million, which will be released to Godiali’s wife pursuant to an agreement with the United States, all of the seized funds will be used to pay the criminal judgment or the FCA settlement. 

“We will not tolerate the use of federal health care programs as a source of personal enrichment,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement demonstrates our commitment to protecting the integrity of those programs and the taxpayer funds used to support them.”

“A priority of my office is protecting our district against unscrupulous health care providers.” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “Dr. Godiali stole an enormous amount of money from both public and private health insurers over a number of years, and falsified medical records to cover up his scheme to defraud. We hope that today’s sentence and substantial civil recovery deter any other physicians likewise inclined to line their pockets at the expense of the public.”

“This provider egregiously stole millions of dollars from taxpayers by billing federal health care programs for services that were neither medically necessary nor rendered to his patients,” said Special Agent in Charge Mario M. Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “As this case demonstrates, HHS-OIG and our partners remain committed to ensuring that vital taxpayer dollars are used lawfully and for their intended purposes, not for the illegitimate financial gain of an individual provider.”

“The scope of Godiali’s fraud is truly stunning,” said Special Agent in Charge James A. Tarasca of the FBI Detroit Field Office. “This investigation proves the collective resources of law enforcement and the private sector can successfully combat fraud in our health care system.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Innovative Solutions Consulting, LLC. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. As part of the civil resolution, Innovative Solutions will receive up to $4,341,900. The qui tam case is captioned U.S. ex rel. Innovative Solutions Consulting LLC v. Vasso Godziachvili Godiali, M.D., Case No. 1:15-cv-14150-TLL-PTM (E.D. Mich.).

The criminal case was prosecuted by Assistant U.S. Attorneys John Neal, Philip Ross, and Craig Wininger for the Eastern District of Michigan. The FCA matter was handled by Senior Trial Counsel Sarah Arni of the Justice Department’s Civil Division and Assistant U.S. Attorney John Postulka for the Eastern District of Michigan. The civil forfeiture action was handled by Assistant U.S. Attorney Philip Ross for the Eastern District of Michigan. These matters received assistance from HHS-OIG, the FBI, the Michigan Attorney General’s Office, and the Michigan Department of Health and Human Services Office of Inspector General. 

Except as to conduct admitted in connection with the criminal resolution, the claims resolved by the civil settlement are allegations only and there has been no determination of liability.

Source: United States Department of Justice News

To highlight the one-year anniversary of the May 25, 2022 Executive Order on Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety, three years after the murder of George Floyd, the Justice Department today is releasing a series of 10 new reports and guidance documents as part of its ongoing efforts to implement the Executive Order.

The steps being announced today include updated guidance prohibiting racial profiling by federal law enforcement agencies, accreditation standards to encourage adoption of policies in the Executive Order by state, Tribal, local, and territorial (STLT) law enforcement agencies, a report on the Department’s efforts to implement the First Step Act, and guidance on officer wellness, investigating in-custody deaths, and responses to individuals in crisis, among others.

“While our work is not done, we are proud of the important changes we have made over this past year to update our internal policies and better provide our state and local partners with the resources and support they need to keep communities safe from violent crime, advance transparency, and build community trust,” said Attorney General Merrick B. Garland.  “As we remember the life of George Floyd on the third anniversary of his death, the Justice Department renews our commitment to advancing accountability in law enforcement and safeguarding the civil rights of all Americans. We recognize that we have a responsibility to lead by example.”

Over the past year, the Department has worked tirelessly on more than 90 Executive Order steps, including robust and substantive engagement with stakeholders from civil rights, law enforcement, and community groups, as well as our federal agency partners.

“The Justice Department’s law enforcement partners are integral to our efforts to protect the American people from violent crime and a wide range of security threats,” said Deputy Attorney General Lisa O. Monaco. “Law enforcement officers are on the front lines every day, across the country, and they deserve our continued support as we work together to ensure equal justice for all. I am proud of the work the Department has done to implement the Executive Order, and in particular the priority it places on officer safety and mental health, to foster a culture of wellness within law enforcement agencies.”

“Public safety requires police-community trust and fair criminal justice policies. The Justice Department has worked hard over the last twelve months to implement the over 90 deliverables from Executive Order 14074, including a focus on mental health, use of force, data collection, officer wellness, reentry, and much more,” said Associate Attorney General Vanita Gupta. “In making progress in all these areas, we have relied on the extensive engagement of our law enforcement and civil rights partners every step of the way. We remain committed to using all of our tools to strengthen trust and build healthy and safe communities.”

In addition to the steps announced today, the Department’s work under the Executive Order includes prohibiting the transfer of or use of federal grant funds to purchase military-style weapons and equipment for STLT law enforcement agencies, awarding grants in a manner that supports and promotes the adoption of the Executive Order’s policies, and working to establish a National Law Enforcement Accountability Database.

All of this work is part of the Department’s abiding commitment to the Attorney General’s three co-equal priorities: upholding the rule of law, protecting civil rights, and keeping our country safe.

Overview of the Justice Department’s Implementation of Executive Order 14074

As part of an all-of-government strategy set forth in the May 2022 Executive Order, the Department is using all of its tools to advance public safety and build police-community trust, while advancing thoughtful, evidence-informed initiatives and reforms throughout the criminal justice system. As the Executive Order makes clear, system-wide change requires funding and support that only Congress can authorize. The mandates of the Executive Order apply only to federal law enforcement agencies.

• To raise the standards of federal law enforcement agencies, the Executive Order requires all federal law enforcement agencies to adopt policies equivalent to the Department’s policies on using force, chokeholds and carotid restraints, no-knock entries, and proper body-worn camera use.
• To promote adoption of the Executive Order’s policies by STLT law enforcement agencies and encourage best practices, the Department is awarding discretionary grants in a manner that supports and promotes adoption of the Order’s policies and has created first-of-their-kind accreditation standards to further encourage adoption. The Department, in collaboration with the Department of Health and Human Services, also published guidance on best practices for responding to calls and interacting with persons in behavioral or mental health crisis or with a disability, and published a report on supporting officer wellness.
• To improve conditions of confinement and promote better outcomes for individuals who are incarcerated or under supervision, the Department published a report on the use of restrictive housing in the Bureau of Prisons (BOP) and BOP’s efforts to reduce its use, a report outlining steps BOP and the U.S. Marshals Service are taking to improve conditions of confinement for individuals in their custody, and a report on the Department’s efforts to fully implement the First Step Act.
• To improve data collection and analysis to help better inform the public, government leaders, and policymakers, the Department is providing training and technical assistance to federal and STLT law enforcement agencies to increase reporting to the FBI’s National Use-of-Force data collection program, the Law Enforcement Officers Killed and Assaulted (LEOKA) data collection program, the Death in Custody Report Act, and the National Incident-Based Reporting System (NIBRS).
• The Department, in collaboration with the Department of Homeland Security, updated the Guidance on the Use of Race, Ethnicity, Gender, National Origin, Religion, Sexual Orientation, and Gender Identity by Federal Law Enforcement Agencies. The updated guidance prohibiting racial profiling by federal law enforcement agencies sets forth limited circumstances when federal law enforcement agents or officers may consider a protected characteristic, adds disability as a protected characteristic, expands application of the guidance beyond law enforcement officers to all federal law enforcement personnel engaged in or supporting federal law enforcement activities, and sets benchmarks and timelines for the development and implementation of training, data collection, and accountability provisions.
• Last month, the Department released a Strategic Plan outlining actions to safely reduce criminal justice system interactions, support rehabilitation during incarceration, and facilitate reentry for people with criminal records.

In the months and years to come, the Department will continue to operationalize and build upon its implementation of the Executive Order to keep communities safe, support law enforcement, and advance effective, fair policing.

The Department’s reports and guidance documents are available here.

The Department’s Fact Sheet on efforts to implement the Executive Order is available here.

Source: United States Department of Justice News

A North Carolina man was sentenced today to 36 months in prison for tax evasion.

According to court documents and statements made in court, Darren Lee Joy of Matthews did not file individual income tax returns for most of the past two decades, even though he was required to do so based on the amount of income he earned. Joy evaded taxes by submitting and maintaining with his employers Forms W-4 and state tax forms that falsely claimed he was exempt from federal and state income tax withholding. As a result, taxes were not withheld from his wages and little to no taxes were paid to the IRS. In total, Joy earned more than $1.8 million in income and owed more than $380,000 in state and federal income taxes. 

In addition to the term of imprisonment, U.S. District Court Judge Frank D. Whitney ordered Joy to serve two years of supervised release and to pay $359,859 in restitution to the United States and $23,058 in restitution to the State of California.

Acting Deputy Assistant Attorney General Stuart M. Goldberg of the Justice Department’s Tax Division, U.S. Attorney Dena J. King for the Western District of North Carolina and Special Agent in Charge Donald “Trey” Eakins of the IRS-Criminal Investigation Charlotte Field Office made the announcement.

IRS-Criminal Investigation investigated the case.

Trial Attorney Brian Flanagan of the Justice Department’s Tax Division and Assistant U.S. Attorney Caryn Finley for the Western District of North Carolina prosecuted the case.