Indian American doctor gets jail for $13 mn insurance fraud

CHICAGO - 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.

(Arun Kumar can be contacted at arun.kumar@ians.in)