Pelham Manor Man Charged With Health Care Fraud And Kickback Scheme

 

Scheme Caused Medicare to Pay at Least $10 Million on Fraudulent Claims

Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), announced the unsealing of a five-count Indictment charging MANISHKUMAR PATEL in connection with a health care fraud and kickback scheme involving the sale of fraudulent prescriptions.  PATEL was arrested this morning in Pelham Manor, New York, and was presented before U.S. Magistrate Judge Gary Stein.  The case is assigned to U.S. District Judge Schofield. 

U.S. Attorney Damian Williams said: “As alleged, Manishkumar Patel ran a scheme to get rich by generating fraudulent prescriptions used to bill Medicare for millions of dollars in unnecessary healthcare expenses.  Today’s charges send a message: our Office and our law enforcement partners are dedicated to holding accountable anyone who tries to rip off critical healthcare programs like Medicare.” 

HHS-OIG Special Agent in Charge Naomi Gruchacz said: “Certain violations of the Anti-Kickback Statute can result in the inducement of medically unnecessary durable medical equipment, medications, and laboratory tests, which can affect the availability of services for others and drive up the cost of health care for everyone.  Individuals and entities that participate in the federal health care system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients.”

As alleged in the Indictment:[1]

Between 2019 and 2022, PATEL and a coconspirator (“CC-1”) fraudulently sold prescriptions and doctors’ orders for durable medical equipment, pharmaceuticals, and laboratory tests (collectively, “scripts”) to durable medical equipment suppliers, pharmacies, and laboratories (collectively, the “Medicare Providers”).

PATEL obtained the scripts from call centers that called Medicare beneficiaries and asked them perfunctory questions designed to justify a script that would be reimbursed by Medicare.  PATEL turned the information from those calls into scripts by, variously: (i) arranging cursory telemedicine appointments with the beneficiaries; (ii) a practice called “doctor chasing,” in which the information was sent to a doctor who signed the script without seeing the patient and who was frequently unaware of what they were signing; and (iii) obtaining forged scripts.  PATEL then sold the scripts to Medicare Providers, which filled the orders and billed Medicare. 

Because the scripts were fraudulently obtained, many beneficiaries rejected the items they were sent by the Medicare Providers, many doctors threatened to report PATEL for fraud, and Medicare frequently refused to pay for the scripts.

The Medicare Providers made payments to PATEL for the scripts in violation of the Anti-Kickback Statue.  PATEL and the Medicare Providers entered into sham contracts for generic marketing services at flat rates in an attempt to conceal their illegal kickback scheme.

PATEL, 44, of Pelham Manor, New York, is charged with (i) conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison; (ii) health care fraud, which carries a maximum sentence of 20 years in prison; (iii) wire fraud, which carries a maximum sentence of 20 years in prison; (iv) conspiracy to violate the Anti-Kickback Statute, which carries a maximum sentence of five years in prison; and (v) violation of the Anti-Kickback Statute, which carries a maximum sentence of five years in prison. 

The maximum potential sentences are prescribed by Congress and are provided here for informational purposes only, as any sentencing of the defendant will be determined by a judge.

Mr. Williams praised the outstanding work of HHS-OIG.

The case is being prosecuted by the Office’s Complex Frauds and Cybercrime Unit.  Assistant U.S. Attorney Kevin Mead is in charge of the prosecution.

The charges contained in the Indictment are merely accusations, and the defendant is presumed innocent unless and until proven guilty.

[1] As the introductory phrase signifies, the entirety of the text of the Indictment and the description of the Indictment set forth herein constitutes only allegations, and every fact described therein should be treated as an allegation.