Radiologist CEO agrees to pay $9M to settle allegations of false claims, referral kickbacks

A radiologist CEO and his practice have agreed to pay nearly $8.9 million to settle allegations of paying kickbacks for referrals and filing false claims with the Medicare program.  

Andrew Gomes, MD, of Sugar Land, Texas, allegedly started establishing clinics across the Lone Star State under the National Interventional Radiology Partners umbrella in 2015. The now 48-year-old purportedly raised capital from podiatrists, primary care docs and family practitioners, who could provide a strong referral base for NIRP to treat peripheral artery disease.

The U.S. Attorney’s Office contends that Gomes promised “high returns” on their investments, with more referrals leading to additional revascularization surgeries. All of this would funnel back to investing physicians as monthly dividends, authorities alleged.

“Medical providers and others who unlawfully accept kickbacks for patient referrals undermine the integrity of medical decision-making and waste taxpayer dollars,” Special Agent in Charge Jason E. Meadows, with the HHS Office of Inspector General, said in a statement issued Aug. 20. "We remain committed to working with our law enforcement partners and prosecutors to hold those who defraud Medicare accountable and restore the integrity of the Medicare trust fund.”

Gomes also allegedly told investors that, once their surgical centers were profitable, they could be sold to create additional value. Surgeries such as arteriograms, angiograms, angioplasties and atherectomies to revascularize lower limbs of PAD patients are “highly compensated,” authorities noted.

U.S. Attorneys caught wind of the alleged scheme after an unnamed individual filed suit on behalf of the federal government. Under qui tam provisions of the False Claims Act, a whistleblower can do so, with the feds later joining if they believe the case has merit. The person first filed the complaint in 2018, triggering the investigation. He stands to receive 19% of the recovery, or $1,687,977. Special Agent Meadows and colleagues call the FCA “one of the most powerful tools” the feds can wield to “combat healthcare fraud.”

“Dr. Gomes and NIRP clearly prioritized greed above the health and well-being of their elderly patients,” FBI Houston Special Agent in Charge Douglas Williams said in the same statement. “We applaud the qui tam whistleblower who exposed this scheme and encourage others to report illegal medical practices.”

The claims resolved by the settlement are only allegations, with no determination of liability, the U.S. Attorney’s Office cautioned. Gomes emphasized this point in a statement shared with Radiology Business Friday (see the whole email at the bottom of this story). 

"It is important to note that while the government has its theories, the settlement agreement expressly states that there is no admission or determination of wrongdoing," he said. "There were no allegations of patient harm, nor of any medically unnecessary care. The fact that there is no corporate integrity agreement fairly indicates that the government saw no need to impose a compliance plan of its making on the operation. The cost and uncertainty of litigation forces us to make a practical business decision so that we can continue to offer high quality patient care to patients at lower costs than available in other settings, such as hospital-based facilities (the most inefficient and costly of all)."

The IR specialist studied medicine at the Louisiana State University in Shreveport. He now works as founding manager at PAD Specialists, an interventional radiology group with 20 locations across Arkansas, New Mexico and Texas. Gomes also is a business consultant for AG PR Consulting and founding manager at TBI Imaging Associates, according to his LinkedIn profile, which makes no mention of NIRP. The social media website lists his location as San Juan, Puerto Rico.

TBI Imaging Associates is headquartered in Houston and has 20-plus affiliated locations across the U.S. The company provides diffusion tensor imaging to diagnose traumatic brain injury, which it says is under-diagnosed among thousands of individuals each year.

“In years past it was not possible to characterize white matter damage to the brain. That is no longer the case. Our goal at TIA is to educate the public on what DTI is, when it is appropriate to obtain for an accident victim, and to facilitate said victim’s DTI scanning and expert witness interpretation in a convenient, accurate, and efficient manner across all 50 states,” Gomes said in a profile posted on TBIA’s website.

Editor's Note: This story has been updated to include a comment from Andrew Gomes, MD: 

"It is important to note that while the government has its theories, the settlement agreement expressly states that there is no admission or determination of wrongdoing. There were no allegations of patient harm, nor of any medically unnecessary care. The fact that there is no corporate integrity agreement fairly indicates that the government saw no need to impose a compliance plan of its making on the operation. The cost and uncertainty of litigation forces us to make a practical business decision so that we can continue to offer high quality patient care to patients at lower costs than available in other settings, such as hospital-based facilities (the most inefficient and costly of all). This saves the patients and the U.S. taxpayer money.  We stand behind our physicians, our facilities, our patients, and our mission to provide high quality care at lower costs to both the patient and the U.S. taxpayer.  We look forward to continuing to serve our patients, our communities, and our partners and believe that having this matter behind us provides an opportunity to grow.
 
PAD is one of the most un- and under-diagnosed diseases in the country. Obesity, along with diabetes and amputations, are on the rise with no end in sight. The morbidity, mortality, and healthcare costs incurred by PAD are catastrophic, and left unchecked, will only get worse. These are the reasons I founded PAD Specialists so many years ago, with the goals of (1) raising awareness of PAD in every community we serve, (2) identifying and treating PAD early and appropriately, (3) alleviating patients' pain and preventing amputations, and (4) lowering healthcare costs by preventing the worsening of disease and shifting procedures from the inefficient and high-cost hospital setting to the safe, effective, and lower cost [office-based lab] setting. I am proud to say that we have accomplished all of these goals. The hundreds of positive patient reviews we have online—and the many loyal referring physicians, both investors and noninvestors, we have in all markets we serve—attest to this. The tens of thousands of patients we have treated over the years received appropriate treatment, and overwhelmingly, their lives were better because of that. 
 
We do have physician investors in our business model, and through hard work and some good fortune, despite a difficult regulatory environment, we have persevered, succeeded, and remain profitable. And yes, if a company is profitable, its investors make money as a reward for taking a risk. That a company makes money is not proof of wrongdoing. Unless a healthcare company is profitable, they will go out of business, and then even fewer patients will receive the care they need.

We appreciate the government's cooperation and are glad to put this matter behind us, so that we may now focus on what matters most, our patients."