Prosecutors said that Dr. Francisco Patino prescribed excessive amounts of opioids to patients and subjected them to unnecessary and painful spinal injections, for which he billed Medicare $50 million.
A Blue Cross employee reported that vascular services provided by a provider, Vasso Godiali, appeared excessive. Godiali of Bay City Vascular was found to be inappropriately using modifiers to unbundle claims leading to overpayments. He was also accused of billing for services that were not provided.
Godiali was arrested and pled guilty. He was placed on prepayment review and terminated from all networks in 2015. He was ordered to pay Blue Cross $4.66 million in restitution. Blue Cross has also filed a civil lawsuit and received a judgement of $12.3 million.
Dr. Manninder S. Deswal of Lansing was accused of issuing prescriptions "in exchange for cash payments, sexual favors, and/or other illicit drugs." He pled guilty in U.S. District Court after being charged with unlawfully prescribing highly addictive opioids. Blue Cross will implement administrative actions against this provider.
Mohamad Ali Makki, RPh, was accused of conspiring with others in fraudulent billing and prescribing drugs to patients without distributing them. In some cases, the medication was prescribed to dead individuals for the purpose of collecting insurance payments.
Makki, of Dearborn Heights, was arrested and ordered to pay Blue Cross $635,000 in restitution. The U.S. District Court ordered Makki to pay a total of $9.8 million in restitution.