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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.

NRI cardiologist charged for bilking more than
$13 million in Medicare and insurance


Chicago, Jan 31, 2009
Satnam Singh

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, Fitzgerald alleged.

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 fraudulent claims.

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.