S>e

UNITED STATES DISTRICT CO URT

SOUTHERN DISTRICT OF FLORIDA

UN ITED STATES OF AM ERICA

cx relEM ILIO LOPEZ,M .D.,

FILED BY D.C.

Mlï152229

cSt.kD.OltFlFltA1,-7MI%A

Plaintiff, FILED IN CWA/FWW AND UN DER SEAL

PURSUANT TO 31U.S.C.j3730(b)(2)

DO NOT SERVE

VASCULAR AND INTERVENTIONAL

SPECIALISTS,LLC,aFloridaLimitedLiability

Company,OSCAR SOSA,M .D .,PETER

CLAYTON,andOSM AN Y DEANGELO,M .D.,

Defendants.

COM PLAINT FOR VIOLATIONS OF THE FALSE CLAIM S ACT

INTRODUCTION

OnbehalfoftheUnitedStatesofAmerica,QuiTam RelatorEmilioLopez,M .D.

(tûltelator'')bringsthisactiontorecoverdamagesandpenaltiesundertheUnitedStatesFalse

ClaimsAct(($FCA''),31U.S.C.j3729etseq.againstDefendantsVascula.randlnterventional

Specialists,LLC ($ûV1S'') OscarSosa,M.D.,PeterClayton,and Osmany DeAngelo,M .D.

DefendantsviolatedtheFCA by submittingorcausingthesubm issionoffalseclaim sforpayment

to M edicare for medically unnecessary angioplasties during dialysis catheter removals or

exchanges,angioplastiesbasedondiagnosticfistulograms,andangioplastiesindeclotprocedures

(altogether,(tsurgeries'').

Federallaw prohibitsM edicarepaym entsfortitem sandserviceswhich ...arenot

reasonableandnecessaryforthediagnosisortreatmentofilnessorinjuryortoimprovethe

functioningofamalformedbodymember.''42U.S.C.j1395y(a)(1)(A).

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DefendantsviolatedtheFCA byknowingly submittingorcausingthesubm ission

offalseorfraudulentclaimstoM edicareform edicallyuzmecessarySurgeries.Defendantsfalsified

medicalrecordstom aketheSurgeriesappearm edicallynecessarywhentheywerenot.Defendants

alsofalselycertifiedtoM edicarethattheSurgerieswerem edicallynecessary,whentheywerenot.

JURISDICTION AND VENUE

ThisactionarisesundertheFCA,31U.S.C.j3729etseq.

ThisCoul'thassubjectmaterjurisdictionoverthisactionpursuantto28U.S.C.j

1331and31U.S.C.j3732($.

6. ThisCourthaspersonaljurisdiction overDefendantspursuantto 31U.S.C.j

3732(a)andFederalRuleofCivilProcedure4(e).

VenueisproperintheSouthernDistrictofFloridapursuantto31U.S.C.j3732(a)

and28U.S.C.j1391.

8. UndertheFCA,31U.S.C.j3729c/seq.,RelatorisanCûoriginalsource''ofthe

infonnationuponwhichthiscomplaintisbased.

9. Thefactsandothercircum stancesallegedinthiscomplainthavenotbeendisclosed

bythem edia,inafederaladministrative,crim inal,orcivilhearinginwhichtheGovernm entorits

agentisaparty,orinanyGovenam entAccountabilityOffice,Congressional,orotherwisefederal

investigation,report,audit,orhearing.

Relator,priorto tiling thisaction,voluntarily disclosedto theUnited Statesthe

materialevidenceandotherinformationuponwhichRelatorbaseshisallegations.

lfthere hasbeen any public disclosure,priorto the filing ofthisaction,ofany

aspectoftheallegationsortransactionsinvolved in thiscomplaint,Relatorhasknowledge that

materiallyaddsto,andisindependentof,thepubliclydisclosedallegaticmsortransactions.

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Al1conditionsprecedenttofilingthisactionhavebeenm etbyPlaintifforwaived

byDefendants.

PA RTIES

The realparty in interestto the claims setforth herein isthe United States of

Am erica.RelatorEm ilioLopez,M .D.isboardcertifiedininterventionalanddiagnosticradiology.

He graduated from the University of M iam iM iller SchoolofM edicine and completed his

residencyattheEmorySchoolofMedicine.Afterhisresidency,hejoinedHarvardMedicalSchool

as a Clinicaland Research Fellow in Vascular and lnterventionallm aging and completed a

fellowship in Vascular InterventionalRadiology at Yale-New Haven Hospital.Between his

fellow ship atYale and startat VIS,Relator practiced lnterventionalRadiology at Jackson

RadiologyAssociatesattheJackson-M adison CountyGeneralHospitalinJackson,Tennessee.

On August 1,2018, Defendant VIS,Relator, and Premier lntelwentional &

Diagnostic Radiology Com.(EûRelator's Corporation'),a corporation thatRelator manages,

entered into an lndependent ContractorAgreem entunder which Relator,acting through his

Corporation, would provide interventional radiology and endovascular services. Relator's

Corporation provided itsservicesto VlS solely through Relator.The lndependentContractor

Agreement'seffedive datewasOdober 1,2018,whieh wasthedateRelatorbeganw orking at

VIS.Relatorworked inthiscapadtyforV1SuntilRelatorand Relator'sCorporation terminated

theIndependentContractorAgreementonAugust26,2019.

DefendantVlS isaFloridalimitedliability company.GaryTie-shue,OscarSosa,

and Peter Clayton constitute the sole m embersofVIS.Gary Tie-shue and Oscar Sosa each

respedively own40% ofVIS.DefendantPeterClaylon ownstherem aining 20% ofVIS.Gary

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Tie-shueistheM anagerofVIS.VlStransactsbusinessat7887NorthKendallDrive,Suite210,

M iam i,FL 33156.

16. Defendant Oscar Sosa is the M edicalDirector atVIS.Sosa is a radiologist

specializing in vascular and interventionalradiology.Sosa,who resides in Florida,is a key

decision-m akeratV1Sandwasintim atelyinvolvedinthefraudulentpracticesthatRelatoralleges

inthiscomplaint,inpal4throughhisinvolvem entinsettingandoverseeingVlS'sbillingpractices

and procedures.Sosadetermined and entered him selfthe CPT billingcodesand patientreports

usedtobillM edicarefortheSurgeriesSosaperform edoroversaw .

DefendantPeterClaytonisVIS'saccountantandExecutiveDirector.Claylon,who

residesin Florida,isakey decision-makeratVlS and wasintim atelyinvolved in thefraudulent

practicesthatRelatorallegesin this complaint.As VlS's accountantand Executive Director,

ClaytonhaddirectknowledgeofDefendants'submissionoffalseclaimsto M edicareandhelped

overseeVIS'scollectionofthoseclaim sfrom M edicare.

18. Defendant Osm any DeAngelo is a radiologist specializing in vascular and

interventionalradiology.Hegraduatedfrom theUniversityofN orthTexasHealth ScienceCenter

College of Osteopathic M edicine and completed a fellowship in vascular and interventional

radiologyatJacksonM em orialHospital.DeAngelo,whoresidesinFlorida,perfonnsm ostofthe

dialysisproceduresatV1SandservesastheM edicalDirectoroftheRadiologyresidencyprogram

atLarkinComm unityHospital.Heisakeydecision-m akeratV1Sandwasintimatelyinvolvedin

the fraudulentpractices thatRelator alleges in thiscom plaint,including by determining and

enteringhim selftheCPT billingcodesandpatientreportsusedtobillM edicarefortheSurgeries

DeAngeloperform ed.

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LEGAL AUTH OW TY

19. TheFCA,at31U.S.C.j3729(a)(1),states:

gAlnypersonwho(A)knowinglypresents,orcausestobepresented,afalse

orfraudulentclaim forpaymentorapproval',(B)knowinglymakes,uses,or

causestobemadeorused,afalsereeordorstatem entmaterialtoafalseor

fraudulentclaim;(C)conspirestocommitaviolationofsubparagraph(A),

(B),(D),(E),(F),Or(G)...or(G)knowinglymakes,uses,orcausestobe

m adeorused,afalserecordorstatem entmaterialtoanobligationtopayor

transm itm oney orpropertytotheGovelmm ent,orknowinglyconcealsor

knowingly and im properly avoids or decreases an obligation to pay or

transm itmoneyorpropertytotheGovernm ent,isliabletotheUnitedStates

Govenunentforacivilpenaltyofnotlessthan$5,000andnotmorethan

$10,000 ...plus3timestheamountofdamageswhichtheGovernment

sustainsbecauseoftheactofthatperson.

20. TheFCA,at31U.S.C.j3729(1))statesthatundertheFCA thetermstknowing'

andûknowingly'(A)meanthataperson,withrespecttoinformation(i)hasactualknowledgeof

theinfonnation;(ii)actsindeliberateignoranceofthetruthorfalsityoftheinformation;or(iii)

actsinrecklessdisregardofthetruthorfalsity oftheinfonnation;and (B)requirenoproofof

specificintenttodefraud.''

BACK GROUND ON M EDICARE AND 1TS BILLING PROCEDURES

CongressestablishedTitleXVIIIoftheSocialSecurityAct,knowlzastheM edicare

pzogram ,in 1965.M edicareprovideshealth insurance servicesfOrindividualsage 65 orOlder,

individualsbelow age65whohavecertaindisabilities,andindividtlals,regardlessofage,withend

stagerenaldisease.See42U.S.C.j426,426-1.

22. TheU.S.DepartmentofHealthandHumanServices(tCHHS'')operatesMedicare

tltroughtheCentersforM edicare& M edicaidServices,afederalagencywithin HH S.

23. M edicareconsistsofthreeparts.Pa14A coversinpatienthospitalcare,including

nursing care and hospice services.Pa14 B coversoutpatienthospitalcare,m edically necessary

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doctors'services,diagnosticand laboratory services,and otherservices. Pal'tD offerscoverage

forprescriptiondrugs.

M edicarecoversonlyservicesthataretûreasonableandnecessaryforthediagnosis

ortreatmentofilnessorinjuryortoimprovethefunctioningofamalformedbodymember.''42

U.S.C.j1395y(a)(1)(A).

25. Doctorsand otherprovidersm ustagreetocertainregulationsandrulesinorderto

enrollasprovidersinM edicare.Theserulesinclude:(a)billingforonlythosecovered services

which aremedicallynecessary;(b)notbilling forany serviceswhich werenotperfonned or

delivered in aecordanee with allapplicable policies;(c)notsubmitting inaccurate orfalse

informationrelatingtoprovidercostsorservices',(d)notengaginginany actoromission that

constitutesorresultsinoverutilizationofservices',(e)beingfullylicensedand/orcertifiedunder

alapplicablestateandfederallawstoperform theprovidedservices;(9 complyingwiththe

applicablestateandfederalstatutes,policiesandregulations',and(g)notengaginginanyillegal

activitiesrelatedtothefurnishingofproductsorservices.

DEFENDANTS'FRAUDULENT PR ACTICES

PhysiciansatVlSPerform edUnnecessaryAngioplastiesDuringDialysis

Procedures,lncludingCatheterRem ovalsandExchanges,Fistulogram s,and

Declots.

26. Anangioplastyisam inim ally-invasivesurgicalprocedureusedtowidendam aged

orobstructedbloodvessels(arteriesorveins).Duringtheprocedure,adetlatedmedicalbaloon

attachedtoacathetcrisinsertedintothcbloodvesselandthcninflatedtoasetsize,thusattempting

toexpandthevesselandimprovebloodt'low.Angioplastiestreatvascularabnonnalities,ineluding

vascularstenosisorocdusions.A stenosisisanarrowingofavessel.Anolxlusion isacomplete

blockageofavessel.

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27. Venogram s and intzavascular ultrasounds are diagnostic tests that detennine

whethera patientsuffers from a vascularabnormality thatwould require intervention such as

angioplasty.A venogram is performed by injecting contrastdye into the vein,which is

subsequently visualized with an x-ray so the physician can determine the vessel'sstatus.An

intravascularultrasound isacatheterwith atiny ultrasound atthetip thatispassed through the

vesselandprovidesanimageofthespaceinsidethevessel.

28. Perfonninganangioplastyrequiresinsertingtheballoonintothevesselfollowing

docum entationofanabnormality,inflatingtheballoon slowly,andthenrem ovingtheballoon.

Physicians atVIS perfonned angioplastiesin three circumstances'.(1)during

dialysiscatheterremovalsorexchanges;(2)basedonadiagnosticfistulogram;and(3)duringa

declotprocedure.

30. A dialysiscatheterisa device used to exchangeblood between apatientand a

dialysismachine forpatientsundergoing hemodialysis for renalfailure.(Hemodialysisisa

procedureforpurifyingthebloodofsuchpatients.)Ifadialysiscatheterismalfunctioning,a

physician mustdetermine the cause of the m alfunction.A m alfunction could be caused by

misalignm entofthe catheterorcould be the resultofa vascularabnorm ality.To assessfora

vascular cause ofm alfunction,a physician would perform a venogram or,in rare cases,an

intravascularultrasound,todeterm inewhetheravascularabnormalityispresent.lfavenogram is

perfonned and showsthepresenceofavascularabnorm ality,angioplasty m ay bewanunted to

treatthevascularabnormalityCtllialysisAngioplasty'').

31. ln some cases,however,ifan initialexam ination ofthepatientindicatesthatthe

dialysiscatheter'sm alfunctioningislikelyduetothecatheter'sm isposition orkinking,itm aybe

reasonabletoexchangethecatheterwithoutfirstperfonningavenogram .ln such cases,afterthe

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catheterisexchanged,thenew catheterwouldbetested.lfthenew catheterisstillm alfunctioning,

avenogram would beperform ed to determ ine whetherthem alfunction resultsfrom avascular

abnonuality.lfthevenogram showsthepresenceofavascularabnormality,aDialysisAngioplasty

maybewarranted.

M oreover,an angioplasty israrelywarranted duringacatheterrem oval.Dialysis

catheterexchangesoccurin situationsthatfarm orefrequentlywarrantperfonuinganangioplasty.

Thisisbecauseacatheterexchangeisperfonnedtofixaproblem- themalftm ctionofthecatheter.

Catheterrem ovals,in contrast,arenonnally perform ed atbedside in the setting ofa normally

functioning catheter. W hile physicians perform angioplasties, technicians and nurses are

com monlytrained toperfonn,and doperform ,bedsidecatheterrem ovals.ltisnotcomm on for

teclmiciansandnursestobetrainedonperforming,ortoperform,catheterexchanges.

33. A DialysisAngioplastyism edicallynecessaryonlyifavenogram orintervascular

ultrasoundisperformedandshowsavascularabnormalityjustifyingtheprocedure.

34. Angioplasties m ay also be performed based on a diagnostic fistulogram

(dkFistulogram Angioplasty')orafteradeclotprocedure(CçlleclotAngioplastf').A fistulaisa

connectionbetweenanarteryand avein,which isaccessedtoperform hemodialysis.

lfafistulaisnotfunctioning appropriately,itismedicallynecessarytoperfonn a

tistulogram to determinethecauseofthemalfunction and thetypeofintervention necessaryto

repairthefistula.Afistulogram isadiagnosticprocedureinwhichdyeisinjectedintothefistula,

which isvisualized by x-ray.The procedure is performed sim ilarly to a venogram . Fistula

m alfunctions can be caused by various factors,including vascular stenosis and occlusions

throughoutthelengthofthefistula,includingthecentralthoracicveins.

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36. A Fistulogram Angioplasty isappropriate only ifthem alfunction iscaused by a

flow limitingstenosiswithnarrowinggreaterthan 50% orocclusion.TheneedforaFistulogram

Angioplasty cannot be determ ined without a fistulogram or intravascular ultrasound. A

Fistulogram Angioplastyismedicallynecessaryonly ifafistulogram isperfonued andindicates

thatanangioplastyismedicallynecessarytorepairthefistula.

A declotprocedureisperformedbyinjectingthrombolytics,medicationsthatbreak

up bloodclots,intoanoccludedfistulaorgrafttobreakupathrombus,abloodclot.Followingthe

removalofathrom bus,afistulogram isperfonned to localizetheabnormality thatm ighthave

causedthefistulatoclot.Ifthefistulogram showsflow lim itingstenosisorocclusion,angioplasty

m aybewarranted.Theneedforanangioplastyafteradeclotprocedure- aDeclotAngioplastyisbasedonfistulogram findings.A DeclotAngioplastyism edicallynecessaryonlyifafistulogram

isperformedandindicatesthatitisrequired.

M edically unnecessary Dialysis Angioplasties, Fistulogram Angioplasties, or

DeclotAngioplastiesposesubstantialand unacceptablerisksto patients.Thesesubstantialrisks

include,butarenotlim itedto,progressiontosymptomaticnarrowingofapatient'sveinsorarteries

whichwerepotentiallynonualattim eofangioplasty,anddeath.

Allthe specific examples ofpatientcases discussed below are m entioned for

illustrativepurposesonly and representonly a sm allportion ofthosecasesofwhich Relatoris

personallyawareinwhich Defendantssubm ittedfalseclaim stoM edicareandreceivedpaym ent

from M edicareonthoseclaim s.

40. Eachphysician atV1SpersonallypreparedthepatientreportsandenteredtheCPT

codesthatV1SusedtobillM edicareforthatphysician'sservices,includingtheSurgeriesthatare

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thesubjectofthiscomplaint.Thiswasdonewith theknowledgeand involvementofV1S's

m anagement,includingSosa,Clayton,andothersworkingforVIS.

From 2015toatleast2019,DefendantsKnowingly Subm itted orCausedto

BeSubmitted FalseClaimstoM edicareforDialysisAngioplasties.

41. In2015,DefendantsfalsitiedmedicalrecordsinordertojustifybilingMedicare

forDialysisAngioplasties,and falsely certified to M edicarethatDialysis Angioplastieswere

m edicallynecessary.

ln 2015,almost all the Dialysis Angioplasties that Defendants subm itted to

M edicareweremedicallyunnecessarybecauseDefendantseither(a)didnotperform venograms

orintravascularultrasoundsjustifyingthem or(b)falsifiedvenogram resultstojustifythem.

43. Defendantsperform ed m any oftheDialysisAngioplastiesdespiteneverhaving

obtained any venogram or intervascular ultrasound, let alone venograms or intelwascular

ultrasounds showing abnonnalities that would m ake the Dialysis Angioplasties m edically

necessary.

M oreover, even in the few cases for which Defendants actually obtained

venograms,Defendants'Dialysis Angioplasties were predicated on fraud.W hen Defendants

obtainedavenogram indicatingtheabsenceofabnorm alities,Defendantsfalsifiedthevenogram 's

results by fraudulently stating on the patient's

abnorm alities.

m edical record that the venogram showed

Relatorpossesses inform ation identifying certain specific procedures in which

Defendantscommittedthefrauddescribedinthiscom plaint.Fullrecordsoftheseproceduresare,

andhaveatalltimesbeen,inthepossessionofDefendants.Becauseheisnolongerworkingwith

Defendants,Relatordoesnothaveaccesstoal1recordsthatwouldprovidefurtherdetails,buthe

10

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doespossesscertainm aterials,andm oreinform ationabouttheprocedurescanbeidentifiedusing

theinform ationprovidedherein.

46. Asaspeciticexampleilustrativeofthefraud,apatient(chal'tnumber18518)

receivedDialysisAngioplasty on December31,2015,duringacatheterexchange.Althoughthe

patient'schartfalsely claim sthatavenogram showed an abnorm ality warrantingtreatment,no

venogram wasinfactperformed.N onetheless,VlSsubmittedaclaim forpaymentunderM edicare,

whichitreceived.

47. As anotherexample,another patient(chartnumber 17488) received Dialysis

AngioplastyonDecem ber31,2015,duringacatheterrem oval.Again,althoughthechartindicates

thatavenogram wasperformedshowingan abnorm alitywarrantingtreatm ent,theim agesin the

patient'sfiledonotcontain avenogram ,andnovenogram wasperform ed.Nonetheless,VlS still

submittedaclaim forpaym entunderM edicare,whichitreceived.

48. Startingin2016,Defendantspracticallyceasedperform ingvenogram s.From 2016

to at least April 2019, Defendants perform ed essentially no venogram s or intravascular

ultrasounds,yetcontinued to billM edicare for Dialysis Angioplasties.From 2016 to 2017,

Defendantsjustifiedtheprocedurebyfraudulentlystatingonpatientmedicalrecordsthatthey

perfonnedvenogram sthatshowedabnormalities.

Asspecificexamples,onApril20,2016,apatient(chartnumber17739)received

aDialysisAngioplastyaspartofacatheterrem oval.Thepatient,however,receivednovenogram .

VlS stillsubm ittedaclaim forpaymentunderM edicare,whichitreceived.

50. lnJune2016,onepatient(chartnumber1622)receivedaDialysisAngioplastyafter

acatheterrem ovaldespitenovenogram beingperform ed.VISstillsubm ittedaclaim forpaym ent

underM edicare,whichitreceived.

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lnJuly2016,anotherpatient(chartnumber20086)receivedaDialysisAngioplasty

afteracatheterexchangeeventhoughnovenogram wasperformed.VlSstillsubm ittedaclaim for

paym entunderM edicare,which itreceived.

52. Asanotherexample,onJuly26,2016,onepatient(chal'tnumber18899)received

aDialysisAngioplasty aspa14ofacatheterrem oval.A venogram wasin factperformed onthat

date,butthevenogram showedno abnonnalities.VlS stillsubmitted aclaim forpaymentunder

M edicare,whichitreceived.

On July 27,2017,anotherpatient(chal'tnumber23562)received a Dialysis

Angioplasty aspartofacatheterexchange,even thoughno venogram waseverperfonned.On

August17,2017,thissam epatientreceivedyetanotherDialysisAngioplastyaspa14ofacatheter

exchange,even though once m ore no venogram wasperfonned.V1S subm itted both Dialysis

AngioplastiesforpaymentunderM edicare,whichitreceived.

On January a patient (chal'tnumber 24116) received a Dialysis

Angioplastyaspal4ofacatheterrem oval,eventhoughnovenogram waseverperfonued.V1S still

submittedaclaim forpaymentunderM edicare,whichitreceived.

55. Beginning in2018,Defendantschangedtheirtactics.lnsteadofclaim ingDialysis

Angioplastieswerejustitied by venogramswhich,in reality,Defendantsneverperformed,

Defendantsstated inpatientmedicalrecordsthattheDialysisAngioplastieswereûsprophylactic.''

Ckprophylactic''Dialysis Angioplasties are facially medically unnecessary because they are

perfonned withoutevidence docum enting thatthe patientsuffersfrom a vascularabnormality

justifyingadialysisangioplasty.

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From 2015toatIeast2019,DefendantsKnowingly Subm itted orCausedtoBe

Subm ittedFalseClaim stoM edicareforFistulogram Angioplasties.

From 2015toatleast2019,Defendantsfalsifiedmedicalrecordsinordertojustify

billingM edicareforFistulogram Angioplasties,andfalselycertifiedtoM edicarethatFistulogram

Angioplastieswerem edicallynecessary.

From 2015to atleastApril2019,Defendantssubmittedto M edicare claim sfor

Fistulogram AngioplastiesforcasesinwhichDefendantseither(1)didnotactuallyperform any

diagnosticfistulogramsor(2)performeddiagnosticfistulogramsthatshowednoabnormalities

justifyingan angioplasty.In both typesofcases,Defendantsfraudulently claimed on patient

medicalrecordsandcertifiedtoM edicarethatDefendantsperform eddiagnosticfistulogramsthat

foundabnonnalitiesjustifyingangioplasties.

Because a Fistulogram Angioplasty ism edically necessary only ifa diagnostic

fistulogram isperform edthatshowsan abnorm ality,theangioplasty casesbased on fraudulent

diagnosticfistulogramswerem edicallyunnecessary.

a specific example,on January 30,2018,a patient(chartnumber 12849)

receivedaFistulogram Angioplasty,butnofistulogram waseverperformed.V1Sstillsubm itleda

claim forpaymentunderM edicare,which itreceived.

60. Asotherexamples,onJuly 11,20l9,apatient(chartnumber20620)receiveda

Fistulogrnm Angioplasty,eventhoughnofistulogram wasperfonned.V1S stillsubm ittedaclaim

forpaym entunderM edicare,whichitreceived.

ThesameOccun'edwithanotherpatient(chartnumber17907)onAugust22,2019.

V1Sstillsubm ittedaclaim forpaym entunderM edicare,whichitreceived.

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From 2015toatIeast2019,DefendantsKnowinglySubm ittedorCausedtoBe

Subm ittedFalseClaim stoM edicareforDeclotAngioplasties.

From 2015toatleast2019,Defendantsfalsifiedmedicalrecordsinordertojustify

billing M edicare for Declot Angioplasties, and falsely certified to M edicare that Declot

Angioplastiesw eremedicallynecessary.

63. From 2015 to atleastApril2019,Defendantssubmitted to M edicareclaim sfor

DeclotAngioplastiesin casesin which Defendantseither(1)did notactually perfonu any

fistulogramsor(2)performed fistulogramsthatshowednoabnormalitiesjustifyingaDeclot

Angioplasty.Inbothtypesofcases,Defendantsfraudulentlystatedinpatientm edicalrecordsand

certitiedtoMedicarethatDefendantsperformedfistulogramsthatfoundabnormalitiesjustifying

DeclotAngioplasties.

64. Because a DeclotAngioplasty is m edically necessary only if a fistulogram is

perform edthatshowsan abnormality,theDeclotAngioplastiesbased on fraudulentfistulogram s

weremedicallyunnecessary.

lndeed,on M ay 15,2019,onepatient(chartnumber27390)receivedaDeclot

Angioplasty atVIS,eventhough thatpatientdidnotreceiveafistulogram .V1S stillsubm itteda

claim forpaym entunderM edicare,which itreceived.

Defendants AIIKnew ofthe FraudulentPracticesand Repeatedly lgnored

Relator's Repeated Efforts to H ave Defendants Cease Their Unlawful

Conduct.

ln Decem ber2018,Relatortold DefendantSosa,V1S's M edicalDirector,that

Relatorwasconcerned thatDefendants were perform ing,and billing M edicare for,medically

unnecessaryDialysisAngioplastiesduringdialysiscatheterremovals.Sosaatemptedtojustify

Defendants'performanceoftheseunnecessaryangioplastiesinpal4bynotinghow wellM edicare

reim bursedDefendantsfortheseangioplasties.Relatorwasunaware,asofDecem ber2018,that

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Defendants were also performing m edieally unnecessary Fistulogram Angioplasties,Declot

Angioplasties,orDialysisAngioplastiesduringdialysiscatheterexchanges.

67. lnJanuaryorFebruary2019,RelatorandanotherphysicianatV1Sraisedconcerns

with SosaandGracieRecio,VlS'sOfficeM anager,thatDefendantswereperforming andbilling

M edieare form edically unnecessary Dialysis Angioplasties during dialysis catheterrem ovals.

AnotherphysicianworkingatV1SsharedRelator'seoneernsandjoinedhim inraisingthem to

Sosaand Recio.Recio defended thepracticein partby noting thatreimbursem entsforDialysis

AngioplastiesduringdialysiscatheterremovalswereanimportantsourceofDefendants'profits.

Sosa listened throughoutthe conversation butm ade no comm ents,never disputing Relator's

concernsorRecio'satemptedjustification.

68. ln January orFebruary 20l9,the otherphysician who shared Relator'sconcerns

raisedtheseconcelmstoDefendantDeAngelo.HetoldDeAngelothatDefendantswereperfonning

and billing M edicare form edically unnecessary DialysisAngioplastiesduring dialysiscatheter

rem ovals.DeAngelo,whoperformedalm ostallDialysisAngioplastiesatVIS,didnotdefendthe

m edicalnecessityoftheproceduresduringhisconversationwiththisphysician.

InM arch 2019,RelatorspokewithDeAngeloregarding separateconcernshehad

aboutVlS'sbillingpracticesrelatingtoitsuseofm edicalTesidentsinm ogramsatPalm Springs

GeneralHospitalandLarkin Comm unityHospital.

70. In M arch orApril2019,DefendantClayton asked Relatorto participate in an

inappropriate plan for radiology services at W estchester Hospital. According to Clayton,

Defendantswereplanning onhavingresidentsatLarkin CommunityHospitaland Palm Springs

General Hospital perform diagnostic radiology readings from VlS's office for patients at

W estchester General Hospital.DeAngelo would sign off on the readings without actually

Case 1:20-cv-22046-KMW Document 1 Entered on FLSD Docket 05/15/2020 Page 15 of 20
reviewing them .Defendants,in turn,would billM edicare as ifDeAngelo had reviewed the

readings.Clayton told RelatorthatifRelatoragreedto bethefaceoftheprogram ,Defendants

wouldofferRelator5% ofthegrossbillingscollected.W henRelatordeclined,statingtheproposal

wasunethicalandillegal,ClaydonofferedtocompensateRelatorûtunderthetable.''Relatorrefused

toparticipatein theproposed program .Relatortheninfonned Sosaofhisconcernszegardingthe

program anddesirenottobeinvolvedwithit.

OnM ay 10,2019,RelatormetwithSosa,Clayton,andTie-shue.Relatorreiterated

hisconcernsregardingDefendants'practices.

ln M ay orJune20l9,Relatorbecam eawarethatDefendantswerecontinuingto

perfonn and billM edicare form edically unnecessary Dialysis Angioplasties during dialysis

catheterrem ovalsand fudher began to notice thatDefendantswere perform ing a significant

volum eofthese fraudulentprocedures.Atthistim e,Relatoralso learned thatDefendantswere

perform ing fraudulent Dialysis Angioplasties during catheter exchanges, Fistulogram

Angioplasties,andDeclotAngioplasties.Defendantswereengaging inthesefraudulentpractices

despiteRelator'searlierconversationsraisingconcel'nsaboutsuchpractices.

lnJune2019,Relatorspokewith Clayton aboutDefendants'continuingpractices

regarding DialysisAngioplastiesduringdialysiscatheterrem ovalsand Relator'srealization that

Defendants'fraudextended aswelltoDialysisAngioplastiesduringdialysiscatheterexchanges,

Fistulogram Angioplasties,andDeelotAngioplasties.DespitetellingRelatorthathewouldfollow

up with Relatorregarding Relator'sconcenzs,Clayton neverfollowed up ortook any effortsto

stopthisconduct.

On June 14,2019,Relatoralsoreiteratedhisconcernsto Sesa,whetooknoacticm

tostopthem .

Case 1:20-cv-22046-KMW Document 1 Entered on FLSD Docket 05/15/2020 Page 16 of 20
75. OnAugust23,2019,RelatoragaindiscussedDefendants'fraudulentpracticeswith

Clayton, Sosa, and DeAngelo.At the meeting, Clayton, Sosa, and DeAngelo offered no

explanationforhow theSurgeriesweremedicallynecessaryandnonfraudulent.Defendantsm ade

itcleartoRelatorthattheirpracticeswouldcontinuedespiteRelator'srepeatedprotestations.

Onvariousoccasions,SosalaughedoffRelator'sconcelms.Forexample,hestated

thatifthegovemmentauditedVIS,DeAngelowouldbetheonlyonegoingtoCjail.''Healso

comm entedthatûtnobodyeverhastopayanyofthem oneyback.''

OnAugust26,2019,Relator,throughRelator'sCorporation,resignedfrom VIS.

CAUSES OF ACTION

COUNT 1

FalseorFraudulentClaim s

FalseClaimsAct,31U.S.C.j3729(a)(1)(A)

(AgainstAIIDefendants)

Relator realleges and incorporates by reference the allegations contained in

paragraphs1through 77ofthiscomplaint.

Defendantsknowinglypresentedorcausedtobepresentedtoanofficer,em ployee,

oragentoftheUnited Statesfalseorfraudulentclaims,namely,theSurgeries,forpaym entbythe

M edicareprogram,inviolationof3lU.S.C.j3729(a)(1)(A).

The United States,through the M edicareprogram,paid such false orfraudulent

claim sbecauseofDefendants'acts.

DuetoDefendants'conductinviolationof31U.S.C.j3729(a)(1)(A),theUnited

Stateshassufferedactualdam ages,includingthetotalam ountstheUnited Statespaidinresponse

totheDefendants'falseandfraudulentclaim sforpaym ent.TheUnitedStatesisentitledtorecover

civilm onetarypenalties,anda11otherreliefasdeemedappropriate.

17

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COUNT 11

FalseRecordsorStatem entsM aterialtoFalseClaim s

FalseClaimsAct,31U.S.C.j3729(a)(1)(B)

(AgainstAllDefendants)

82. Relator realleges and incorporates by reference the allegations contained in

paragraphs1tluough77ofthiscomplaint.

Defendantsknowinglym ade,used,orcausedtobem adeorused,afalserecord or

statem entm aterialtoafalseorfraudulentclaim ,nam ely,theSurgeries,in violation of31U.S.C.

j3729(a)(1)(B).

TheUnited States,tllrough the M edicare program ,paid such false orfraudulent

claim sbecauseofDefendants'acts.

85. DuetoDefendants'conductinviolationof31U.S.C.j3729(a)(1)(A),theUnited

Stateshassufferedactualdam ages,includingthetotalam ountstheUnitedStatespaidinresponse

totheDefendants'falseandfraudulentclaimsforpayment.TheUnitedStatesisentitledtorecover

civilmonetarypenalties,andallotherreliefasdeem edappropriate.

CO UNT l1l

Conspiracy

FalseClaimsAct,31U.S.C.j3729(a)(1)(C)

(AgainstAIIDefendants)

Relator realleges and incorporates by reference the allegations contained in

paragraphs1through77ofthiscomplaint.

87. Defendantsconspiredtocommitaviolationof31U.S.C.j3729(a)(1)(A),(B),(D),

(E),(F),or(G)inviolationof31U.S.C.j3729(a)(1)(C).

The United States,through the M edicareprogram ,paid such falseorfraudulent

claim s,nam ely,theSurgeries,becauseofDefendants'acts.

18

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DuetoDefendants'conductinviolationof31U.S.C.j3729(a)(1)(C),theUnited

Stateshassufferedactualdam ages,includingthetotalam ountstheUnitedStatespaidinresponse

totheDefendants'falseandfraudulentclaim sforpaym ent.TheUnitedStatesisentitledtorecover

civilm onetarypenalties,andallotherreliefasdeemedappropriate.

CO UNT IV

UnjustEnrichment

(AgainstAllDefendants)

Relator realleges and incorporates by reference the allegations contained in

paragraphs1through77ofthiscomplaint.

Thisisa claim underfederalcomm on law forthe recovery ofmoniesby which

Defendantshavebeenunjustlyemiched.

DuetoDefendants'conductdescribedinthiscomplaint,Defendantswereunjustly

enriched atthe expense ofthe United Statesin an am ountto be determined,which,underthe

circum stances,inequity andgood conscience,shouldbereturnedtotheUnitedStates.

JURY DEM AND

Relatordemandsatrialbyjuryona1lissuessotriable.

PRAYER FOR RELIEF

Wherefore,Relatorrespectfulypraysforjudgmentinitsfavorasfollows:

a. ThatthisCourtenterjudgmentagainstDefendantsinanamountequaltothreetimes

theam ountofdam agesthattheUnited StateshassustainedbecauseofDefendants'acts,plusa

civilpenaltyof$11,000foreachviolationof31U.S.C.j3729,andthecostsofthisaction,with

interest,includingcoststotheUnited Statesforitsexpensesrelatedtothisaction;

b. ThattheRelatorbeawarded allcostsineun-ed,andreasonableattonwys'fees;

Case 1:20-cv-22046-KMW Document 1 Entered on FLSD Docket 05/15/2020 Page 19 of 20
That,intheeventtheUnitedStatesintervenesinthisaction,Relatorbeawarded25

percentofanyproceedsoftheclaim ,andthatintheeventtheUnitedStatesGovernmentdoesnot

intervene,Relatorbeawarded30pereentofanyproceeds;

d. ThattheUnited Statesand Relatorshallreceive allfurtherrelief,both legaland

equitable,towhichtheym ayreasonablybeentitled.

Dated:M ay 15,2020 Respectf l1ySubm itted,

#

GERALD E.GREENBERG

FloridaBarN o.440094

gMreenberg@gsgpmcom

FREDDY FUN ES

FloridaBarNo.87932

funes@zsgpa.com

ANDREW J.FULLER

FloridaBarNo.1021164

afuller@ gsqpmcom

GELBER SCHACHTER & GREENBERG,P.A .

1221BrickellAvenue,Suite2010

M iami,Florida33131

Telephone:(305)728-0950

Facsimile:(305)728-0951

E-service:efilincs@zsapa.com

CounselforRelatorEmilioLopez,M D.

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