The government contends that claims were submitted for services not provided, and in other instances, claims were submitted without proper documentation. This was the second false claims case for this cardiologist. In May 2000, Galichia and Galichia Medical Group agreed to pay more than $1.5 million to settle a previous False Claims Act matter. In that case, the government contended that between 1993 and 1998, Galichia billed Medicare for a higher level of services than provided (up-coding), billed twice for the same services, and billed for services not provided. The settlement agreement says it is neither an admission of liability by Galichia and the medical group nor a concession by the government that its claims aren't well-founded.
As part of the $1.3 million settlement, Galichia and Galichia Medical Group have entered into an Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General (OIG). The Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
Commentary: The press release issued by the Justice Department presents a one-sided view of the facts and portrayed the conduct at issue as fraud.
For a more balanced view of the facts (including links to the settlement agreement and integrity agreement), the Wichita Eagle's March 4, 2009 article is helpful. Attorney Gary Ayers, who represents Galichia and Galichia Medical Group, was quoted in the article as saying they signed the settlement agreement rather than going to trial. As lawyers in this field know, settlement is quite common since the expense and risk of going to trial is significant. Ayers said the government had no proof that services weren't provided and said the documentation was a matter of interpretation. "We don't think it's fair," he said, but "a lot of times it's easier to settle and go on."
In the article, Ayers was also quoted as saying audits over the years since then found "a very, very low error rate, meaning our documentation was great" until government auditors used a new interpretation of the documentation guidelines. The new interpretation, he said, required certain portions of the records to be in a doctor's own hand, rather than dictated by the doctor and written by a nurse. "It's that simple," he said. "It's another example of Medicare changing its interpretation of the rules." Ayers said documentation was in patients' records; the only question, he said, was "could Dr. Galichia use the nurse as a scribe?"
The agreement says that the federal Centers for Medicare and Medicaid suspended payments to Galichia and the medical group. As of March 31, 2008, the suspended amount was $3.1 million, it says. It says $1.3 million of the suspended payments will be kept by the government as part of the settlement agreement. Within 30 days of the agreement, it says, the government will end the suspension and release the balance of the funds to Galichia and Galichia Medical Group.
See a copy of the settlement agreement:
See a copy of the Integrity Agreement:
Any questions or comments should be directed to: firstname.lastname@example.org. Tracy Green is a principal at Green and Associates in Los Angeles, California They focus their practice on the representation of individuals, licensed professionals and businesses in civil, administrative, and criminal proceedings, with a specialty in health care providers.