Deeper Than the Headlines: Alleged EGD Billing Missteps from Bariatric Surgeon

In a recent case, a general and bariatric surgeon agreed to pay $45,000 plus interest to resolve allegations related to improper billing practices involving esophagogastroduodenoscopies (EGDs) performed on bariatric patients. The settlement comes as part of an investigation by the U.S. Attorney’s Office for the Eastern District of Pennsylvania and the U.S. Department of Health and Human Services Office of Inspector General. 

From January 1, 2019, to March 31, 2020, the doctor allegedly submitted false claims to Medicaid and Medicare, billing for EGDs that were not fully completed. The procedures were intended to thoroughly examine the esophagus, stomach, and duodenum, but in this case, the duodenum was reportedly omitted to expedite the process.  

Under the qui tam provisions of the False Claims Act, a former employee of Steward Easton Hospital played a pivotal role in bringing these allegations to light.