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Dr. Scott H. Saffold, the local ear, nose, and throat specialist agreed earlier this month to pay $625,000 to end a civil fraud lawsuit.
The lawsuit alleged that Saffold and his medical practice falsely billed government healthcare programs systematically, according to a statement released by the Eastern District of the U.S. Attorney’s office.
Saffold has offices in Belle Haven, Franklin, Suffolk, Churchland, and Virginia Beach.
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Federal and state governments alleged that Saffold and his Chesapeake Bay ENT office billed for balloon sinus dilations that were not medically necessary and that procedures were performed at separate times “to increase reimbursement from government payors and without any medical justification.”
The government also alleged Saffold and his company routinely billed government payors for endoscopies with sphenoid sinusoscopy under codes that were not performed.
“The settlement arises in connection with a lawsuit filed under the whistleblower provision of the False Claims Act,” the statement noted.
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Such a suit “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.”
Online information about Saffold’s state license does not mention the lawsuit. His initial license was obtained on March 16, 2001. His current license expires on Oct. 31, 2026.
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The sealed lawsuit was filed in August 2018. In it, Erin Craig, a data scientist involved in using electronic health records to improve health care and hospital care, complained that a diagnostic endoscopy is a dangerous and complex procedure that involves puncturing the patients’ facial bones. She investigates Medicare fraud and otolaryngology frauds.
The lawsuit states that Saffold was enrolled in the Medicare Program and is paid in excess of $600,000 a year in Medicare Part B payments.
The lawsuit alleged that “Saffold files many Medicare claims for balloon sinus dilations, far more than anyone in Virginia, and nationwide number three in 2016, and number four in 2015.”
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However, the lawsuit also noted Saffold “has not filed claims for the surgical treatment of nasal polyps, deviated septums, or enlarged turbinates.” It stated, “research supports that 25-30% of chronic rhinosinusitis patients have symptomatic polyps. But Dr. Saffold’s claims show he does not surgically treat his patients’ polyps.”
“Observing and diagnosing sinuses by puncturing a patient’s facial bones risks patient harm and is rarely necessary because the diagnosis can be made with a CT scan, or with an endoscope inserted through a patient’s nostril,” the lawsuit continues.
“Dr. Saffold claims too many… diagnostics, including duplicates. Significantly, Dr. Saffold claims this procedure more than once per patient. During the three years 2014 through 2016, data shows it paid for approximately 120 duplicate procedures…”
