ATLANTA – Advanced Urology, Inc., Dr. Jitesh Patel, and affiliated entities have agreed to pay $14 million to resolve allegations of fraudulent billing and medically unnecessary procedures, in violation of the False Claims Act and the Georgia False Medicaid Claims Act.
The settlement addresses claims that the provider billed federal healthcare programs—including Medicare and Medicaid—for procedures that were either not performed or lacked medical necessity, raising serious concerns about patient safety and misuse of public funds.
Federal authorities emphasized that such practices undermine both trust and resource allocation within healthcare systems.
“Physicians commit fraud when they seek payment for medically unnecessary procedures or bill for services they never performed,” said U.S. Attorney Theodore S. Hertzberg, underscoring the government’s commitment to enforcing accountability.
Allegations of Systemic Overutilization
The case originated from whistleblower complaints filed by a former employee and a physician, who alleged that Advanced Urology prioritized revenue generation through unnecessary and improperly billed procedures.
According to the allegations, the organization engaged in multiple questionable practices, including:
- Implanting sacral nerve stimulators without adequate patient evaluation
- Performing excessive cystoscopy and retrograde pyelogram procedures requiring anesthesia
- Routinely administering electromyography tests—rarely used in urology—on new patients
- Ordering thousands of unnecessary ultrasound scans
- Billing for Direct Visual Internal Urethrotomy (DVIU) procedures that were not actually performed, instead conducting less complex treatments while claiming higher reimbursement
These practices, if proven, reflect a pattern of upcoding and overtreatment, which not only inflates healthcare costs but also exposes patients to avoidable risks.
Multi-Agency Investigation
The investigation involved coordination across multiple federal and state agencies, including:
- U.S. Department of Health and Human Services (HHS-OIG)
- Federal Bureau of Investigation (FBI)
- Department of Veterans Affairs (VA-OIG)
- Department of Defense (DCIS)
- Georgia Attorney General’s Medicaid Fraud Division
Officials across agencies highlighted the broader implications of healthcare fraud, particularly its impact on vulnerable populations and taxpayer-funded programs.
Whistleblower Role and Settlement Terms
The case was brought under the qui tam provisions of the False Claims Act, which allow private individuals to file lawsuits on behalf of the government. The whistleblowers in this case will receive approximately $2.94 million from the settlement.
Importantly, the agreement resolves allegations only, and there has been no determination of liability.
A Broader Signal to the Industry
This settlement serves as a reminder of the increasing scrutiny on healthcare providers and the critical importance of clinical integrity, accurate billing, and ethical patient care.
As enforcement actions intensify, healthcare organizations face growing pressure to ensure compliance—not only to avoid financial penalties, but to maintain trust in systems designed to deliver equitable and necessary care.
