United States Attorney Jacqueline C. Romero announced that Dr. Maneesh Ailawadi, MD, a bariatric surgeon in Allentown, has agreed to pay $45,000 plus interest to resolve False Claims Act allegations that he caused the submission of false claims by submitting inappropriate claims to Medicaid and Medicare. This was allegedly done by improperly billing esophagogastroduodenoscopies on bariatric patients at the former Steward Easton Hospital in Easton.

EGDs are procedures that examine the lining of the esophagus, stomach and the first part of the small intestine – the duodenum. These are performed to identify symptoms that may be new, cannot be explained, or are not responding to treatment. The findings from an EGD can help surgeons decide on the most appropriate bariatric procedure and follow up care.

Dr. Ailawadi had privileges to perform bariatric surgeries and EGDs at Steward Easton Hospital. The government alleges that Ailawadi submitted false claims for payment to both Medicaid and Medicare from Jan. 1, 2019 to March 31, 2020.

According to the United States, these EGD procedures were only partially completed to save time, although Ailawadi billed the federal health care programs as if they had been fully completed.

By failing to enter the duodenum during the EGD procedure, Ailawadi allegedly was not able to identify any abnormalities, such as bleeding, growths, ulcers or inflammation.

“The United States Attorney’s Office for the Eastern District of Pennsylvania places a high priority on enforcement in cases involving health care fraud,” said Romero. “We will hold accountable those who bill the Federal Healthcare Programs for procedures that are either not performed, or partially performed, as was the case here.”

“Today’s settlement shows our attention to and commitment to investigating allegations of fraud targeting Medicare and Medicaid, whether we need to examine the potential conduct of an individual physician or several parties in a complex scheme,” said Maureen R. Dixon, special agent in charge for the U.S. Department of Health and Human Services Office of Inspector General.

This settlement resolved a lawsuit filed under the False Claims Act in the U.S. District Court for the Eastern District of Pennsylvania by a former Steward Easton Hospital employee.