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Indian physician pleads guilty in USD 19 million healthcare fraud

PTI November 15, 2014 9:23 IST

New York: A 59-year old Indian physician has pleaded guilty for his role in a USD 19 million healthcare fraud scheme in which he submitted fraudulent claims for home visits and directed false referrals for home health care by his employee physicians.

Rajesh Doshi of Michigan yesterday pleaded guilty to conspiracy to commit healthcare fraud and one count of health care fraud and would be sentenced in March next year, Assistant Attorney General Leslie R Caldwell of the Justice Department's Criminal Division said.

According to his plea agreement, 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 care to Medicare for reimbursement.

Doshi admitted that he submitted these false claims through Home Physicians Services (HPS), a medical practice he owned in Michigan.

He also paid kickbacks to recruiters to obtain Medicare beneficiaries and home health agencies owned by co-conspirators.

He 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.  
Between October 2005 and September 2012, Doshi and his co-conspirators caused Medicare to pay more than USD 19 million based on false claims.