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.
Sheth, of Burr Ridge, and whose office was in Flossmoor, also was ordered to pay restitution totaling approximately $13 million and agreed to forfeit property and funds totaling more than $11.3 million that the government seized from him, according to the statement.
In a related criminal proceeding, "Sheth admitted using his hospital privileges to obtain information about patients without their knowledge or consent," the DoJ statement said. "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."
Sheth submitted more than 14,800 false claims for care that required hands-on treatment in an intensive care unit on multiple days during the patients stay, the DOJ statement says. He "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."