A federal jury in Detroit on Oct. 26, 2012, convicted a physician, a home health agency owner, and a patient recruiter for their participation in a $14.5 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Robert Foley III, Special Agent in Charge of the FBI Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Detroit Office.
Dr. Pramod Raval, 59, was found guilty in U.S. District Court for the Eastern District of Michigan of one count of conspiracy to commit health care fraud and one count of conspiracy to solicit or receive health care kickbacks in exchange for referring patients to two Detroit area home health care companies, Patient Choice Home Healthcare Inc. and All American Home Care Inc.
Chiradeep Gupta, 38, a physical therapist and part-owner of All American, was found guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to commit money laundering, and three substantive counts of money laundering. The charge of health care fraud conspiracy carries a maximum penalty of 10 years in prison and a $250,000 fine. The charge of conspiracy to violate the Anti-Kickback Statute carries a maximum prison sentence of five years and a fine of up to $25,000.
Richard Shannon, 39, a patient recruiter, was found guilty of one count of conspiracy to commit health care fraud.
The defendants were charged in a superseding indictment returned March 27, 2012. Sixteen other individuals who worked at or were associated with Patient Choice and All American have previously pleaded guilty.
According to evidence presented at trial, the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare through Patient Choice and All American, two home health care companies located in Oak Park, Michigan that purported to provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area.
The evidence showed that the defendants and their co-conspirators used patient recruiters who paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. The owners of Patient Choice and All American paid physicians to sign referrals and other therapy documents necessary to bill Medicare. Physical therapists and physical therapist assistants provided through contractors would then create fake medical records using the blank, pre-signed forms obtained by the patient recruiters to make it appear as if physical therapy services were actually rendered, when, in fact, the services had not been rendered.
According to evidence presented at trial, Raval referred both patients from his own practice and patients brought into the scheme by recruiters to Patient Choice and All American in exchange for kickbacks. Gupta provided to Patient Choice and All American physical therapists and physical therapist assistants who created fake patient files using blank, pre-signed forms obtained by patient recruiters, to make it appear as if the physical therapy services billed to Medicare had actually been given. Gupta also doctored and directed the doctoring of fake patient files. The evidence at trial showed that Gupta laundered the proceeds of the fraud through multiple shell companies. Shannon paid patients in cash in order to obtain their signatures on blank physical therapy forms used to create fake therapy documents.
Vishnu Meda, a physical therapist assistant at Patient Choice and All American, was acquitted of one count of conspiracy to commit health care fraud.
The case was prosecuted by Assistant Chief Gejaa T. Gobena and Trial Attorneys Catherine K. Dick and Niall M. O’Donnell of the Criminal Division’s Fraud Section. The investigation was led by the FBI and HHS-OIG, and was brought by the Medicare Fraud Strike Force, a joint effort of the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. (FBI press release)
To learn more about the Health Care Fraud Prevention and Enforcement Action Team, click (HEAT).