Michigan Physician Pleads Guilty for Role in $19 Million Medicare Fraud Scheme
How were the Medicare beneficiaries whose information was used in this fraud scheme affected by records of diagnoses they didn’t have and services they neither needed nor received?
A Detroit-area physician, who orchestrated the submission of fraudulent claims for physician home visits and directed fraudulent referrals for home health care by his employee physicians as part of a $19 million home health care fraud scheme, pleaded guilty today for his role in the conspiracy.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.
Dr. Rajesh Doshi, 59, of Bloomfield Hills, Michigan, pleaded guilty before Senior U.S. District Judge Arthur J. Tarnow of the Eastern District of Michigan to conspiracy to commit health care fraud and one count of health care fraud. The sentencing hearing is set for March 3, 2015.
According to his plea agreement, Dr. Doshi admitted that between October 2005 and September 2012, he conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care that was not medically necessary, and then submitting false and fraudulent claims for the purported care to Medicare for reimbursement. Dr. Doshi admitted that he submitted these false claims through Home Physicians Services (HPS), a medical practice he owned in Southfield, Michigan. Although Dr. Doshi owned HPS, he hid his ownership because of prior state court convictions.
Specifically, Dr. Doshi admitted that he paid kickbacks to recruiters to obtain Medicare beneficiaries for HPS and home health agencies owned by co-conspirators. Dr. Doshi and his co-conspirators then falsified medical and billing records for purported physician home visits, sometimes adding diagnoses to make it appear that the beneficiaries qualified for and required home care when they did not, and other times, “upcoding” physician home visits to higher levels of complexity than actually performed.
Dr. Doshi also admitted that he solicited and received kickbacks from home health agency owners in exchange for the referral of beneficiaries to those agencies, regardless of whether the beneficiaries qualified for or needed home health care. He then directed HPS physicians to falsify medical documentation and certify Medicare beneficiaries as homebound even though the HPS physicians had never met the beneficiaries or the beneficiaries were not actually homebound.
Between October 2005 and September 2012, Dr. Doshi and his co-conspirators caused Medicare to pay more than $19 million based on false claims. Three other physicians and one physician assistant have already pleaded guilty for their involvement in the health care fraud conspiracy related to the scheme at HPS.
This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. This case is being prosecuted by Trial Attorney Niall M. O’Donnell of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
SOURCE: Department of Justice