Indian American doctor gets jail for $13 mn insurance fraud
Chicago(USA), Aug 12, 2010: An Indian American doctor has been sentenced to five years in federal prison for defrauding the government's Medicare and 30 other public and private health care insurance programmes of about $13 million.
Cardiologist Sushil Sheth, 50, a former Chicago area physician, was sentenced Tuesday by US District Judge Rebecca Pallmeyer and ordered to begin serving the prison term in two months.
He pleaded guilty a year ago to one count of health care fraud after being charged in January 2009.
Sheth was also ordered to pay restitution totalling about $13 million, and he agreed to forfeit property and funds totalling more than $11.3 million that the government seized from him.
Sheth's medical license was suspended by the Illinois Department of Professional Regulation in March. His attorney said at the sentencing hearing that Sheth had surrendered his license.
Sheth "lied thousands of times to Medicare and other insurers in order to receive millions of dollars he did not earn for patients he never treated", the US attorney's office said in a statement Thursday.
He used the fraud proceeds to live a lavish lifestyle, purchasing a suburban mansion, property in Arizona, luxury automobiles and investing in various venture capital opportunities, prosecutors said.
Sheth regularly submitted claims seeking payment that, when added together, had him providing more than 24 hours of medical services and treatment in a single day, they said.
Sheth admitted that he obtained about $13 million between January 2002 and July 2007, including about $8.3 million from Medicare and some $5 million from other public and private health care insurers.
He got the money in fraudulent reimbursement for the highest level of cardiac care when those services were not performed, and then used the proceeds for his own benefit, prosecutors said.
Sheth used his hospital privileges at three unnamed hospitals to access and obtain information about patients without their knowledge or consent, federal officials said.
He then hired individuals to bill Medicare and other insurance providers for medical services that he purportedly rendered to patients whom he knew he never treated, the officials said.
Federal agents searched Sheth's Chicago home in June 2007 and seized more than 600 uncashed cheques from various insurers totalling more than $6.7 million.
cardiologist charged for bilking more than
$13 million in Medicare
Chicago, Jan 31, 2009
NRI Dr. Sushil Sheth, cardiologist, 49, charged of
healthcare fraud, who allegedly collected more than $13 million
from Medicare and private insurers for treatment he never provided,
according to U.S. Attorney Patrick Fitzgerald.
In court documents filed Jan. 28 in U.S. District
Court in Chicago, Fitzgerald alleges that cardiologist Sushil Sheth,
whose office is in south suburban Flossmoor, obtained patient names,
insurance information and dates during which those patients were
admitted to hospitals where he held staff privileges.
Between 2002 and 2007, Sheth billed $8.3 million
to Medicare and $5.1 million to other insurers for intensive cardiac
care he purportedly provided on multiple days during those stays,
Dr. Sheth, hired individuals to bill Medicare and
other insurance providers for medical services he purportedly rendered
to patients he never treated, the release said. According to the
complaint, he faxed handwritten treatment notes to the billers describing
care he gave patients. The notes allegedly were included with the
Patrick J. Fitzgerald, United States Attorney
for the Northern District of Illinois said:
- Health care fraud remains an important priority of federal law
enforcement. We will use all of our resources to ensure that dishonest
physicians and other medical providers do not profit from cheating
Medicare and private insurers
- If convicted, each count carries a maximum penalty of 10 years
in prison and a $250,000 fine. The Court, however, would determine
the appropriate sentence to be imposed under the advisory United
States Sentencing Guidelines.
- The public is reminded that charges are not evidence of guilt.
The defendants are presumed innocent and are entitled to a fair
trial at which the government has the burden of proving guilt
beyond a reasonable doubt.
- The charges seek forfeiture of approximately $13.4 million
and two parcels of real estate in Scottsdale, Ariz.
- The Government has seized or restrained approximately $11.3
million in various bank and investment accounts held by Sheth
and his wife.
- The government is being represented by Assistant U.S. Attorney
Steven J. Dollear. The case was investigated by the FBI and the
Inspector General’s offices of the Department of Health
and Human Services and the Labor Department.
- Sheth, of Burr Ridge and whose business office is in Flossmoor,
will be arraigned at a later date in U.S. District Court.
Sheth graduated from Grant Medical College in Mumbai,
India, and received his residency with the University of Bombay
Hospitals, according to Ingalls Health System's Web site.
He holds medical license and 19 years of practice
in Illinois. There is no legal or disciplinary action in the past.