Forsyth County Urology Center Pays $14 Million to Settle Federal Billing Fraud Allegations

Dr. Jitesh Patel, the founder and owner of Advanced Urology, Inc., agreed to pay $14 million to settle federal and state allegations that his practice billed Medicare, Medicaid, and TRICARE for urological procedures that were either never performed or medically unnecessary, including at the company's Cumming office inside the Forsyth Physicians Center on Deputy Bill Cantrell Memorial Road. The U.S. Department of Justice's Northern District of Georgia announced the settlement on April 3.

The case began inside the practice itself. Two separate whistleblower lawsuits, the first filed in 2018 by former employee Lorraine Perumal-Szramel and the second filed in 2019 by former Advanced Urology physician Dr. Himanshu Aggarwal, triggered the federal investigation. Under the False Claims Act's qui tam provisions, which allow private citizens to sue on the government's behalf and share in any recovery, both will collectively receive $2.94 million from the settlement.

Prosecutors described a billing structure built around revenue rather than need. According to the allegations, Advanced Urology implanted permanent Sacral Nerve Stimulator devices in patients without first testing whether those patients would benefit. It placed patients under anesthesia for cystoscopy and retrograde pyelogram procedures, which involve inserting a scope through the urethra and into the bladder, without medical justification. It administered Electromyography tests, a procedure rarely used in urology that transmits electrical signals through the body, to nearly every new patient.

The most concrete example of the alleged fraud involved a technique known as upcoding. Advanced Urology allegedly performed a simple urethral dilation, then billed federal programs for a far more expensive surgery called a Direct Visual Internal Urethrotomy, or DVIU, which requires a scope and a knife to cut tissue inside the urethra. The billing code for DVIU pays significantly more than a basic dilation, so submitting the wrong code meant collecting more than the law allows.

"Fraud against the Medicaid program is stealing from Georgia taxpayers, plain and simple," said Jim Mooney, Deputy Attorney General of Georgia's Medicaid Fraud and Patient Protection Division. "Performing unnecessary procedures takes limited resources away from those who truly need them."

The settlement resolves both lawsuits filed in U.S. District Court. Advanced Urology and Patel do not admit wrongdoing under the agreement; the claims remain allegations with no determination of liability.

For any patient who received care at the Cumming office or Advanced Urology's other locations, Medicare beneficiaries have the legal right to request an itemized bill from their provider and dispute charges with their insurer. Compare the procedures listed on your Explanation of Benefits against what you actually experienced during your visit. Charges for procedures performed under anesthesia, implanted devices, or specialized scopes warrant particular scrutiny. The HHS Office of Inspector General accepts fraud tips at 1-800-HHS-TIPS (1-800-447-8477). Medicare billing complaints go directly to 1-800-MEDICARE (1-800-633-4227). Georgia Medicaid concerns reach the Attorney General's Medicaid Fraud and Patient Protection Division, the state agency that co-prosecuted this case alongside federal prosecutors.

The investigation was conducted jointly by the FBI's Atlanta field office, the HHS Office of Inspector General, and the Defense Criminal Investigative Service. The settlement does not resolve potential criminal liability, and no charges have been filed.