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Taking Care of Business

Taking Care of Business

Healthcare-7
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

A nurse practitioner from Waxahachie, Tex., was sentenced for his role in a healthcare fraud conspiracy. Trivikram Reddy, 39, pleaded guilty to conspiracy to commit wire fraud in October 2020 after participating in a scheme that defrauded Medicare and private insurance providers out of millions of dollars.

Reddy, a licensed nurse practitioner, defrauded Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana, and Cigna. (At least he’s an equal opportunity fraudster. Every company had their fair shot at being scammed.)

Reddy and his co-conspirators created false patient bills using the provider numbers of six doctors as the treating physicians on the claims. All the claims were false and at no time did the six doctors provide billable services to any of Mr. Reddy’s medical clinics. (That was my guess.)

On June 3, 2019, federal agents served a civil investigative demand at one of Reddy’s medical clinics. When law enforcement arrived at the site, agents found Reddy’s staff manufacturing medical records. (They were caught red-handed but still denied that they were doing anything fishy.)  Following the encounter, on June 8, Reddy closed the clinic and terminated his business entity with the Texas Secretary of State.

On June 13, 2019, Reddy made the first of multiple wire transfers which, in sum, totaled more than $55 million. (Just a small amount there. Surely, that would not trigger the government’s interest.) A forensic financial analysis directly tied the money to fraudulent health care claims submitted by Reddy. (Reddy thought that he could escape into the sunset with his fraudulent funds, but the government had other plans.)

Federal agents requested medical records to justify millions of dollars of Medicare claims paid between January 2014 and June 2019. Reddy and his staff spent the next four months manufacturing fake medical records to turn over to authorities. (They dug themselves deeper and deeper into a hole with each fraudulent document.)

As a result of this scheme, Reddy was sentenced to 20 years in federal prison and ordered to repay more than $52 million in restitution. (Looks like the government didn’t waste any time taking care of Reddy’s fishy business.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Nurse Practitioner Sentenced to 20 Years, Ordered to Pay More Than $52 Million in Restitution,” published on May 26, 2021.

A Waxahachie nurse practitioner was sentenced yesterday to 20 years in federal prison and ordered to repay more than $52 million in restitution for his role in a health care fraud conspiracy, announced Acting U.S. Attorney for the Northern District of Texas Prerak Shah.

Trivikram Reddy, 39, pleaded guilty to conspiracy to commit wire fraud in October 2020.  He was sentenced on Tuesday by U.S. District Judge Ada Brown.

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