An Indian-American has been sentenced to 81 months in prison and asked to pay $9.7 million in restitution along with his accomplices for his role in the $18 million health insurance scam.
Suresh Chand, 46, had pleaded guilty on September 2, 2009, to one count of conspiracy to commit health care fraud and one count of conspiracy to launder money.
The Department of Justice and Health and Human Services said between January 2003 and March 2007, Chand and his co-conspirators submitted claims to the Medicare programme totalling more than $18 million for physical and occupational therapy services that were never provided.
Medicare actually paid approximately $8.5 million on those claims, a statement said.
According to court documents, Chand owned and controlled a company operating in Warren called Continental Rehab Services (CRS), which purported to provide physical and occupational therapy services to Medicare beneficiaries.
He later started another corporation at the same address in Warren called Pacific Management Services (PM), which also purported to provide physical and occupational therapy services to Medicare beneficiaries.
Chand admitted that, beginning around January 2003, he and his associates at CRS, and later PM, began to create fictitious therapy files, appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services were provided.
The fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by Chand and two of his co-conspirators.
In his plea, Chand admitted that in order to create the fictitious therapy files, he and his co-conspirators recruited and paid cash kickbacks and other inducements to Medicare beneficiaries, in exchange for the beneficiaries’ Medicare numbers and signatures on documents falsely indicating that they had visited CRS or PM for the purpose of receiving physical or occupational therapy.
Chand acknowledged recruiting hundreds of Medicare beneficiaries for this purpose, and paying them for their signatures with cash and prescriptions for controlled substances, including Vicodin, Xanax and Soma.
Chand and his co-conspirators obtained the prescriptions for these drugs from co-conspirator physician Jose Castro-Ramirez, who prescribed controlled substances for beneficiaries he had never seen, for the purpose of recruiting those beneficiaries into the scheme.
Chand also prepared fictitious therapy prescriptions and other documents, which when signed by Castro-Ramirez, falsely indicated he had ordered and monitored physical or occupational therapy services that were provided to the Medicare beneficiaries.
To complete the fictitious files, Chand admitted that he and his co-conspirators obtained signatures from licensed physical or occupational therapists on “progress notes” and other documents in the therapy files, falsely indicating that the therapists had provided therapy services to the Medicare beneficiaries on those dates.
Chand recruited a number of licensed physical and occupational therapists into the scheme, and paid these therapists a set fee per file that they helped falsify.