New York Doctor Sentenced to 13 Years in Prison for Multi-Million Dollar Health Care Fraud

[nitpicker]

https://www.justice.gov/opa/pr/new-york-doctor-sentenced-13-years-prison-multi-million-dollar-health-care-fraud

Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Wednesday, February 7, 2018

New York Doctor Sentenced to 13 Years in Prison for Multi-Million Dollar Health Care Fraud

A New York surgeon who practiced at hospitals in Brooklyn and Long Island was sentenced today to 156 months in prison for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare.
(snip)

Syed Imran Ahmed M.D., 51, of Glen Head, New York, was sentenced by U.S. District Judge Dora L. Irizarry of the Eastern District of New York, who also ordered Ahmed to pay $7,266,008.95 in restitution, to forfeit $7,266,008.95, and to pay a $20,000 fine. Ahmed was convicted in July 2016 after an 11-day trial of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering.
(snip)

According to evidence presented at trial, Ahmed, a surgeon who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform. Ahmed wrote out lists of phony surgeries and sent the lists to his billing company in Michigan with instructions that they be billed to Medicare. Ahmed also directed that the surgeries be billed as though they had taken place in an operating room so as to increase the payout for the fraudulent scheme, the evidence showed.

The evidence introduced at trial showed that Medicare paid over $7 million to Ahmed for fraudulent claims.
(snip)

[mr_lebowski]

1. So how come the Rabobank NA Execs aren't going to prison and forfeiting their ill-gotten gains?

[Princess Turandot]

2. He appears to have been caught because one of his patients carefully reviewed...

...their explanation of benefits (EOB) from both Medicare and their supplemental insurance (AKA Senior-care) plan that covered any required coinsurance payments. They saw billings for numerous wound debridement procedures that had never occurred, and called the fraud hotline number on the EOB.

According to one court document, during the period in question, Ahmed submitted bills for 2,143 procedures under one specific procedure code (CPT code 27301). The 2nd highest submissions from one physician for this code? All of 127 of them.

[Docreed2003]

3. Strange cpt code for fraud

That code is for I&D of abscess of the femur or thigh. It must reimburse well for him to use it so frequently, but it was sure to raise red flags because of the rarity of the procedure. If I was among to commit fraud, I think I’d find a more low key cpt code