Qui Tam

Two Chicago Cardiologists Charged With Medicare Fraud

By Marcella Auerbach

Chicago, Illinois?  Cardiologist Sughil Sheth received $13.4 million over a period of five years (2002-2007) by billing Medicare for reimbursement of extensive cardiac care that was not, according to U.S. Attorney Patrick Fitzgerald, ever performed.  Sheth allegedly performed Medicare Fraud by hiring individuals to falsify patient names, insurance data, and dates in order to bill $8.3 million to Medicare and $5.1 million to other insurers.

In the second case,  general practitioner Otto Garcia Montenegro was charged with healthcare fraud?for using his Chicago-area clinic to submit false claims over a period of four years (2003-2007). Rather than collecting co-pays and deductibles from his patients in accordance with the standard procedure, Montenegro submitted hundreds of claims to insurers for treatments that were never performed.  As a result, he collected nearly $900,000 in payment from health care insurers and exhausted patient deductibles in the process.

Regarding their cases, United States Attorney Patrick Fitzgerald said: “Healthcare 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.?

While this announcement involved criminal indictments, it is likely that prosecutions under the federal False Claims Act will follow.

To read the full press release, http://chicago.fbi.gov/dojpressrel/pressrel09/jan30_09.htm

Full post as published by Medicare Fraud 101 on February 10, 2009 (boomark / email).