Dr. Scott Saffold, of Virginia Beach, and his practice, Chesapeake Bay, ENT, P.C. (Chesapeake Bay), located in Belle Haven, have agreed to pay $625,000 to settle a civil fraud case that claimed Dr. Saffold and his medical practice engaged in the routine and systematic practice of falsely billing government health care programs.
The United States and the Commonwealth of Virginia alleged that Saffold and Chesapeake Bay billed federal and state payors for balloon sinus dilations that were not medically necessary.
The government alleged that Saffold and Chesapeake Bay performed these surgeries on six sinuses for many patients even when there was no medical indication of need in some or all dilated sinuses.
The government further alleged that Saffold and Chesapeake Bay staged these procedures, performing each side at separate times to increase reimbursement from government payors without any medical justification.
The government also alleged that Saffold and Chesapeake Bay routinely billed government payors for endoscopies with sphenoid sinusoscopy under Current Procedural Terminology Code 31235 when they were not actually performing that code.
The settlement arises in connection with a lawsuit filed under the whistleblower provision of the False Claims Act.
A whistleblower suit, or qui tam action under the False Claims Act, is commenced by an individual filing a complaint under seal in the U.S. District Court and providing a copy of the complaint and evidence to the U.S. Attorney’s Office.
The United States then has an opportunity to investigate the claims. The False Claims Act provides whistleblowers with a share of the government’s recovery.
