On Tuesday, August 30, 2016, U.S. District Judge William H. Walls described the conduct of a New Jersey couple as “frightening and scary” as he sentenced Kirtish N. Patel and his wife Nita K. Patel to 100 months and 78 months in federal prison, respectively.  The husband and wife duo were also ordered to pay $4.8 million in restitution.  Both Patels pleaded guilty to one count of health care fraud in November 2015.

Court records show that they operated two mobile diagnostic companies that traveled to primary care physicians’ offices to administer tests, which then were supposed to be sent to an outside physician to interpret.  However, rather than having to pay the outside physician to interpret the tests, Kirtish Patel, who is not a physician would read the test and Nita Patel would forge a physician’s signature in order for their company to bill Medicare, Medicaid and private insurance companies for these tests.  The result of this fraud was that patients, unbeknownst to them, would never have their diagnostic heart and neurological tests reviewed by an outside physician, obviously putting their health in serious danger.

In a separate civil False Claims Act case, the Patels were ordered to pay $5 million in damages and $2.75 million in civil monetary penalties.  The civil complaint echoed the criminal charges, alleging that the defendants created fraudulent diagnostic test reports, forged physician signatures on these reports, then billed Medicare for the fraudulent reports and underlying tests.  The complaint also alleged that the defendants billed Medicare for neurological tests that they conducted without the required physician supervision.

The civil case, which originally alerted the government to this egregious fraud scheme, was filed under the qui tam provisions of the False Claims Act.  The qui tam provisions allow private citizens with knowledge of fraud against the government to bring civil actions on behalf of the United States and to share in any recovery the government makes.  The False Claims Act also allows the government to intervene, or take over the lawsuit, as the government did in this case.  The whistleblower in this case was a former employee of one of the Patels’ diagnostic companies, Biosound Medical Services.  As mandated by the False Claims Act, the whistleblower will receive 15 to 25 percent of the $7.75 million recovered by the government.

To report fraud, contact Frohsin Barger & Walthall.