Pittsburgh Indian News Corner
Dr. Samirkumar J. Shah was found guilty by a federal jury on two counts of health care fraud.
According to the evidence submitted in the court:
...between 2008 and 2013, Shah, a practicing cardiologist, submitted fraudulent claims to private insurance companies—Highmark Blue Cross Blue Shield (Highmark), UPMC Health Plan (UPMC), and Gateway Health Plan (Gateway)—as well as government insurance programs—Medicare and Medicaid—for an outpatient treatment known as External Counter Pulsation, or ECP. ECP involves the use of a specialized bed equipped with pressure cuffs, which exert pressure upon patients’ lower extremities as a means to increase blood flow to the heart.
...insurers only reimbursed for ECP treatments of patients who suffered from disabling angina—or chest pain caused by decreased blood flow to the heart—and only when a physician supervised the treatment.
In total, Shah purchased 25 beds and offered ECP to patients at more than 18 locations in Western Pennsylvania, Ohio, New York, and Florida.
..in order to acquire new patients, Shah advertised ECP as "the Fountain of Youth," claimed that it made patients "younger and smarter," and offered the treatment for a range of ailments other than disabling angina, including obesity, migraines, high blood pressure, low blood pressure, diabetes, and erectile dysfunction. After signing up new patients, including many patients who never experienced chest pain, Shah instructed his employees to indicate that every patient had disabling angina on billing sheets that were used to support false insurance claims. In certain instances, Shah never met patients for whom he billed for ECP treatments.
..contrary to health insurance requirements, ECP treatments routinely occurred while neither Shah nor any other medical doctor was present at his various locations. On one such occasion, a patient experienced an adverse event during his ECP treatment and had to be transported via ambulance to the hospital.
In addition to billing for ECP treatments that were not medically necessary and were not provided under direct physician supervision, Shah also double-billed insurers by using a so-called "bundled" ECP code, which accounted for and included payment for various incidental procedures, and then separately submitted claims for the same included procedures. The evidence at trial further established that during reviews initiated by various insurers, Shah routinely submitted fabricated patient files and made false statements concerning his practice, his patient population, his record keeping, and his compliance with applicable coverage guidelines.
Penalty for Health Care FraudPittsburgh Indian Cardiologist Samirkumar J. Shah. faces a maximum potential penalty of ten years in prison, a fine of $250,000, or both.
Samirkumar J. Shah’s sentencing is scheduled for November 6, 2019.
In addition to the prison term Mayank Mishra was also slapped with a three years of supervised release by United States District Judge Cathy Bissoon.
According to information presented to the court:
Mayank Mishra and other members of his family operated stores that sold drug paraphernalia, including diluents used to manufacture heroin and the glassine bags in which heroin is typically sold. In February 2013, federal agents executed search warrants at the business and home of Mishra, and those searches revealed that Mishra was selling drug paraphernalia. He was released on conditions of bond, which, among other things, precluded him from violating any federal or state law.The drug trafficking investigation against Mayank Mishra, a resident of Glenshaw, PA was funded by the federal Organized Crime Drug Enforcement Task Force Program (OCDETF).
Subsequent to his release, law enforcement received information that Mayank Mishra was continuing to sell cutting agents and glassine bags. Based on that information, law enforcement used a confidential informant to purchase cutting agents and glassine bags from Mayank Mishra, and the confidential informant successfully recorded the transaction. The confidential informant explicitly asked for "cut" and "bags", and Mayank Mishra provided a material typically used to dilute heroin and the bags typically used to store and sell heroin. Based on that information, law enforcement obtained another set of search warrants for Mayank Mishra’s business and home, where law enforcement found more cutting agents, glassine bags, marijuana paraphernalia, and $86,000 in cash. Law enforcement arrested Mayank Mishra a second time, and this time the Court did not release him on bond.