Indian-origin doctor jailed for 5 years for insurance fraud

An Indian-origin cardiologist has been sentenced to five years in prison for defrauding the US government's Medicare scheme and other public and private health care insurance programmes of a whopping $13 million through false medical claims.

Sushil Sheth, a Chicago area physician, was sentenced yesterday by US district judge Rebecca Pallmeyer and ordered to begin serving the 60-month prison term in two months.

50-year-old Sheth, who had already surrendered his medical licence, pleaded guilty a year ago to one count of health care fraud after being charged in January 2009.

He was also ordered to pay restitution totalling approximately $13 million and he agreed to forfeit property and funds worth more than $11.3 million that the government seized from him.

He had privileges at three unnamed area hospitals and lied thousands of times to Medicare and other insurers in order to receive millions of dollars for medical services he purportedly rendered to patients he never treated, according to a US Department of Justice statement.

Sheth, whose business office was in Flossmoor, used the fraud proceeds to live a lavish lifestyle, purchasing a suburban mansion, property in Arizona, luxury automobiles and investing in various venture capital opportunities, it said.

"Health care fraud is one of the highest priorities of federal law enforcement. We will make every effort to recover any fraudulently obtained funds and to ensure that dishonest physicians and other medical providers do not profit from cheating Medicare and private insurers," Patrick J Fitzgerald, US attorney for the Northern District of Illinois, said.

Sheth admitted that he obtained approximately $13 million between January 2002 and July 2007, including approximately $8.3 million from Medicare and some $5 million from over 30 other public and private health care insurers in fraudulent reimbursement for the highest level of cardiac care when those services were not performed and then used the proceeds for his own benefit.

The justice department statement said Sheth used his hospital privileges to access and obtain information about patients without their knowledge or consent.

He then hired individuals to bill Medicare and other insurance providers for medical services that he purportedly rendered to patients whom he knew he never treated.

Typically waiting almost a year after the treatment was purportedly provided, Sheth submitted more than 14,800 false claims for reimbursement for providing the highest level of cardiac care requiring hands-on treatment in an intensive care unit on multiple days during patients' hospital stays.

Sheth regularly submitted claims seeking payment that, when added together, had him providing more than 24 hours of medical services and treatment in a single day.

Federal agents searched Sheth's Burr Ridge home in June
2007 and seized more than 600 uncashed checks from various
insurers totalling more than $6.7 million.