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Oath-breaking for Money-making

Oath-breaking for Money-making

Healthcare-8
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

A Pennsylvania cardiologist risked the health of his patients to fill his pockets with taxpayer dollars. Dr. Samirkumar J. Shah, 58, of Fox Chapel, was convicted of two counts of healthcare fraud following an eight-day jury trial and sentenced for his oath-breaking actions.

Between 2008 and 2013, Shah used his professional status to take advantage of his patients in order to make millions of dollars. (To say this doctor was money hungry is an understatement.)

Evidence from the trial supports that Shah submitted fraudulent claims to private insurance plans and government insurance programs for external counter pulsation, or ECP. This treatment increases blood flow to the heart by using specialized bed equipment that exerts pressure to patients’ lower extremities. ECP treatment is only reimbursed by insurers if the treatment is supervised by a physician and if the patient suffers disabling angina.

As part of the scheme, Shah bought 25 ECP beds, which he offered to patients across Western Pennsylvania, Florida, Ohio, and New York. These patients were solicited by advertising ECP as a “Fountain of Youth” that makes patients “younger and smarter”. (Shah was simply spewing a fountain of lies.)

The treatment was then provided to people with a variety of ailments outside of angina, such as obesity, migraines, high blood pressure, low blood pressure, diabetes, and erectile dysfunction. (Sounds like a miracle cure for every ailment.) Despite the lack of chest pain in many of these acquired patients, Shah had his employees mark every patient as having disabling angina on the insurance billing sheets.

Thankfully, the recruited patients underwent precautionary diagnostic ultrasounds prior to receiving ECP treatments. But Shah did not evaluate the ultrasound imagery to rule out blood clots that could result in strokes or heart attacks during the ECP treatments. (The doctor seems to care for his patients even less than he cares for the law.)

Health insurance required Shah or a medical doctor to be present at the time of treatment. Court documents show that Shah placed his patients at risk of serious injury or death by not being present during the treatments. On one occasion, a patient had to be transported in an ambulance to a hospital after experiencing an adverse of event during his treatment.

Shah used a “bundled” ECP code to double bill insurers for the unnecessary ECP treatments. His scheme involved submitting more than $13 million worth in claims, $3.5 million of which was received. (No amount of money should be enough to risk innocent lives.)

As if he hadn’t already made enough mistakes, Shah missed his original sentencing and the judge put out a warrant out for his arrest. He has since been sentenced to 78 months in prison followed by three years of supervised release. He must also pay $1.2 million in restitution and a $500,000 forfeiture money judgment.

Today’s Fraud of the Day comes from a Department of Justice press release, “Fox Chapel Cardiologist Sentenced to 78 Months in Prison for Health Care Fraud Scheme Involving More Than $13 Million of Insurance Billings,” dated August 5, 2021.

PITTSBURGH – A resident of Fox Chapel, Pennsylvania, was sentenced in federal court following his conviction at trial on two counts of health care fraud, Acting United States Attorney Stephen R. Kaufman announced today.

United States District Judge David S. Cercone sentenced Samirkumar J. Shah, 58, to 78 months of imprisonment followed by three years of supervised release.

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