Advanced Urology: Unnecessary Procedures and a Different Surgery Code

In the Advanced Urology settlement, the practice and a physician defendant agreed to pay $14 million over allegations of medically unnecessary procedures and billing for surgery they never performed. If you worked with the orders, procedure notes or claims, the allegations turn on things you may have seen firsthand: why the care was ordered and what actually happened in the procedure room.

The Justice Department announced the civil settlement on April 2, 2026. The allegations covered claims to government healthcare programs, including Medicare and Medicaid, under the False Claims Act and the Georgia False Medicaid Claims Act. The announcement also addressed TRICARE and veterans’ healthcare programs.

Two Whistleblower Complaints, Two Views of the Practice

A former Advanced Urology employee filed the complaint that started the government’s investigation, alleging unnecessary procedures. A former practice physician filed a second complaint alleging that the practice billed government health care programs for procedures and tests that were unnecessary or never performed. The settlement resolved both qui tam lawsuits in the Northern District of Georgia.

The whistleblowers alleged that the practice was organized to maximize revenue for the physician defendant and others through unnecessary procedures and tests. Their account reached from the decision to order care to the description used to bill for it. Those are different places for a false claim to begin, and different people inside a practice may know what happened at each.

The Alleged Unnecessary Procedures and Tests

The medical-necessity allegations concerned permanent implants, invasive procedures and diagnostic testing. The Justice Department described the whistleblowers’ allegations in concrete terms:

• Sacral nerve stimulators. Advanced Urology allegedly implanted permanent devices without first determining whether the patient would benefit.
• Cystoscopy and retrograde pyelograms. The practice allegedly performed numerous unnecessary procedures involving anesthesia and a small scope passed through the urethra into the bladder.
• Electromyography. The practice allegedly performed this test on almost every new patient even though it was rarely used in urology practices. The test transmitted electrical signals through an electrode attached to the patient’s genitalia.
• Ultrasounds. The whistleblowers alleged that the practice ordered thousands of unnecessary tests, including duplex and retroperitoneal ultrasounds.

We see the absurdity in the electromyography allegation: a test rarely used in urology becoming routine for almost everyone who walks in. The patient bears the procedure while the practice bills for it. In the alleged stimulator scheme, the missing step came before a permanent implant: determining whether it would help that patient.

The economics are familiar. The Robert Wood Johnson Foundation’s 2008 report, Physician Self-Referral and Physician-Owned Specialty Facilities, explains that fee-for-service payment rewards a high volume of services and that imaging can generate revenue with little additional physician time. It also describes higher payment rates for procedural and imaging services than for cognitive services, the work of evaluating and advising patients. The allegation against Advanced Urology was that unnecessary care became a way to pursue that revenue.

The same need to connect a procedure to its clinical justification appears in Tri-City Cardiology’s vein-ablation settlement. There, the government alleged that incorrect measurements or documentation of blood flow, vein diameter, symptoms and prior conservative treatment supported unnecessary procedures. For an insider, the useful detail is the patient’s actual condition and how it was represented to justify the bill.

Dilation Billed as Direct Visual Internal Urethrotomy

Advanced Urology allegedly performed a less complicated urethral dilation but billed government programs for direct visual internal urethrotomy to obtain a higher payment. The government’s description of the urethrotomy involves a scope to dilate the urethra and a knife to cut tissue inside it. The whistleblowers alleged that the practice never performed the operation it billed.

This procedure upcoding allegation changes the identity of the service on the claim. A tissue-cutting operation commands payment for work that simple dilation does not include. Under the whistleblowers’ account, the more elaborate surgery existed on the bill. We start with the procedure note and the people who were there, then follow that account into the code submitted for payment.

Five Years of Independent Claims Review

Advanced Urology’s corporate integrity agreement with the Health and Human Services Office of Inspector General requires five years of compliance obligations. The independent claims review examines whether services paid by Medicare were medically necessary, properly documented and correctly coded, submitted and reimbursed.

The agreement covers Advanced Urology Anesthesia, LLC, Surgery Center of Lawrenceville LLC, Urology Surgery Center Johns Creek LLC and Sandy Springs Center for Urologic Surgery LLC, among its named entities. It also covers Advanced Management Solutions, LLC for the management services it provides to Advanced Urology.

That review puts the clinical and billing questions beside each other. For each annual review, the reviewer selects a random sample of 100 paid Medicare claims, with the inspector general able to focus the review on particular locations, items or services.

The documentation rules have teeth. A sampled claim with no supporting documentation counts as an error, and its entire reimbursement counts as an overpayment. The practice cannot substitute another claim for the one missing its support. Additional documents accepted after the initial review must be identified and explained in the report.

We see the practical point in those requirements: the history of a document matters alongside what it says. The agreement also requires the review report to describe the billing and coding systems, the roles of the people using them and the controls intended to keep the claims accurate. That is work an insider may know directly.

What Evidence Does a Whistleblower Need?

For allegations like these, useful physician billing fraud evidence connects the care ordered and performed to the claim requesting payment. For the dilation allegation, we compare the procedure record with the billed surgery. For the necessity allegations, we examine the patient’s clinical information, the reason for the order, the test or procedure record and the resulting claim.

The Journal of AHIMA’s 2017 article Busting Bad Medicine: A Call to Action Addressing Healthcare, Fraud, Waste, and Abuse emphasizes treatment dates, treatment descriptions and signatures in the health record. It also makes a point that fits a case started by people who worked inside the practice:

A code shows what the practice charged. A clinician, coder or billing employee may explain how that description was chosen, what the underlying documentation said and who directed the decision. We work with that account to connect the medical record, the payment request and the decisions behind both.

How Much of a Settlement Does a Whistleblower Get?

The two Advanced Urology whistleblowers were allocated a collective $2.94 million from the settlement. That reward recognizes the insider contribution behind the government’s case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know the Procedure Behind the Bill

If you saw urology tests ordered without a patient-specific reason or a claim describing surgery the patient never received, speak to one of our Whistleblower Experts about what happened. We build your strongest healthcare whistleblower case with you, bring in healthcare fraud whistleblower lawyers who understand procedure billing and medical necessity, and stay beside you as the case develops.