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Two new healthcare fraud cases top $2 million in alleged illegal activity

A pair of physicians and one Las Vegas practice are under fire for an array of alleged offenses including fraud and identity theft.

Beth Jones Sanborn, Managing Editor

Add two more healthcare fraud cases to the ever-expanding list. 

In the first, Las Vegas medical practice Cardiovascular and Thoracic Surgeons of Nevada will pay $1.5 million to settle allegations that they violated the False Claims Act through illegal billing, the Department of Justice announced.

The settlement resolves allegations that for five years, from January 1, 2006 through May 31, 2011, the practice violated the False Claims Act by billing federal healthcare programs, including Medicare and the U.S. Department of Veterans Affairs, for surgical services that were never actually rendered to its cardiac patients.

[Also: Aetna whistleblower accuses CVS Health's Caremark of fraud in Medicare Part D drug prices]

The allegations also state that the practice billed for more expensive surgical, evaluation and management services than were provided. The principal physician for the practice is Bashir Chowdhry, according to the DOJ.

"Physicians who engage in cost mischarging for services provided to veterans will be aggressively pursued by the Office of Inspector General and held accountable to the full extent of the law," said Special Agent in Charge A.E. Pleasant for the U.S. Department of Veterans Affairs.

There has been no determination of liability in this case.

The second case is from suburban Illinois. A physician has been indicted on federal fraud charges for allegedly pocketing nearly $1 million in Medicare and private insurer payments for services that never happened.

Pranav Patel, a physician who owned and operated Palos Medical Care in Palos Heights, is the subject of a 12-count indictment alleging that he submitted fraudulent claims for medical tests and examinations that were never performed, as well as used some patients' names without their knowledge to submit fraudulent claims, the DOJ announced. The indictment charges that from 2008 to 2013, Patel fraudulently obtained, or caused his clinic to obtain, at least $950,000 in payments from Medicare and Blue Cross and Blue Shield of Illinois.

For instance, the indictment described at least one occasion where Patel prepared a seven-page electronic medical record indicating that a patient had come to the office for a follow-up visit and examination, when the patient had actually come to refill a prescription.

Patel is charged with seven counts of healthcare fraud, three counts of making false statements in relation to a healthcare matter, and two counts of aggravated identity theft.  

Healthcare fraud is punishable by up to ten years per count, while false statements carry a maximum of five years. Aggravated identity theft carries a mandatory sentence of two years in prison.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

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