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Physician to Settle Medicare Fraud Case for $20M

Cheryl Clark, for HealthLeaders Media, October 1, 2010

A Chicago cardiologist who had staff privileges at three hospitals will pay $20 million to settle accusations that he lied "thousands of times to Medicare" and more than 30 other public and private health insurers to receive reimbursement for patients he never treated, according to a U.S. Department of Justice statement.

Sushil Sheth, M.D., will begin a five-year prison term on separate criminal charges stemming from these fraudulent claims, according to a statement released by the U.S. Attorney's office for the Northern District of Illinois.

Sheth, "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," in the civil case, the statement said.

The case involves a lawsuit filed under whistleblower provisions of the federal False Claims Act by a fellow physician in 2006. That physician, Lokesh Chandra, MD, will receive 17.5% of any amounts collected from Sheth by the U.S. or the state of Illinois.

According to that lawsuit, Chandra had a contract with Sheth to have him cover hospital rounds and patients when Chandra was out of town or otherwise unavailable. Sheth saw patients at Ingalls Memorial Hospital in Harvey and Advocate South Suburban Hospital in Hazel Crest. He also had privileges at St. Margaret Mercy Healthcare Centers in Hammond.

"Between 2002 and 2007, Sheth submitted false claims seeking payment from Medicare and Medicaid for services at the highest level of in-patient cardiac care when in fact, those services were not performed," according to the statement.

 

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