United States and State of Illinois File Complaint in Intervention in False Claims Act Lawsuit Against Chicago-Area Medical Practice and Billing Company for Allegedly[...]

CHICAGO - The United States and the State of Illinois have filed a joint complaint in intervention alleging that a Chicago-area medical practice and billing company knowingly submitted fraudulent claims to Medicaid and Medicare, resulting in the payment of more than $5.2 million in false claims.

The government's complaint alleges that FOOT & ANKLE HEALTH CARE CENTER, LTD., EUROPEAN FOOT & ANKLE SURGICAL CARE, LTD., their owner, DR. VADIM GOSHKO, and the billing companies, ATLANTIC WAVE HOLDINGS, LLC and ATLANTIC WAVE II, LLC, knowingly submitted fraudulent claims to Medicaid for podiatry services performed by Dr. Goshko after he had already been terminated from the Medicaid program. Because Illinois Medicaid was no longer paying Dr. Goshko's claims, the defendants allegedly worked together to submit claims that listed other physicians as having provided the podiatry services that were actually performed by Dr. Goshko. Although Dr. Goshko and other defendants had an affirmative obligation to inform Medicare of his exclusion from Medicaid, the complaint alleges that they failed to do so. Medicare eventually revoked Dr. Goshko's privileges after learning of his Medicaid exclusion.

As a result of the fraud, the United States and the State of Illinois, through the Medicare and Medicaid programs, paid the defendants more than $5.2 million in federal and state monies to which the defendants were not entitled, the complaint states.

The government's complaint was filed on Monday in U.S. District Court in Chicago. The government had previously notified the Court that it was intervening in a lawsuit filed by PayrHealth, LLC, which had acquired the billing company in December 2020, under the whistleblower provisions of the False Claims Act. After acquiring the billing company, PayrHealth discovered the Goshko entities' fraudulent conduct, terminated them as clients, and notified the government of the alleged fraud. The government's complaint seeks treble damages and civil penalties under the federal False Claims Act, the Illinois False Claims Act, and common law claims for payments by mistake and unjust enrichment.

The lawsuit was announced by Andrew S. Boutros, United States Attorney for the Northern District of Illinois; Kwame Raoul, Illinois Attorney General; Ryan Whalen, Acting Special Agent-in-Charge of the Chicago Field Office of the FBI; and Mario Pinto, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services, Office of Inspector General. The government is represented by Assistant U.S. Attorney Valerie R. Raedy of the U.S. Attorney's Office and Deputy Chief Melissa Guske of the Illinois Attorney General's Office.

The False Claims Act permits private individuals to sue for false claims on behalf of the government and to share in any recovery. The Act allows the government to intervene or take over the lawsuit, as it has done in this case, and to recover three times its damages plus civil penalties ranging from $5,500 to $11,000 for each false claim. Medicaid is a state-administered program, and each state sets its own guidelines regarding eligibility and services. For Illinois Medicaid recipients, funding is shared between the federal government and the State of Illinois.

The case is captioned as United States and State of Illinois, ex rel. PayrHealth v. Foot Ankle, et al., No. 21 C 2536 (N.D. Ill.). The public is reminded that civil allegations are only accusations, and there has been no determination of liability. In a civil case, the government has the burden of proving the allegations by a preponderance of the evidence.