Cardiologist convicted in 'fountain of youth' billing fraud scam

A federal jury found Samirkumar J. Shah, MD, guilty in a healthcare fraud scheme involving more than $13 million in insurance billings, according to the Department of Justice.

Dr. Shah, a cardiologist, was found guilty of two counts of healthcare fraud after an eight-day trial. Evidence introduced at trial showed he submitted fraudulent claims to private and government payers for an outpatient treatment known as external counter pulsation, which involves using pressure cuffs on patients' lower extremities to increase blood flow to the heart.

Dr. Shah offered ECP treatments to patients in Pennsylvania, Ohio, New York and Florida for a variety of ailments, including obesity, migraines and erectile dysfunction. Dr. Shah advertised ECP as "the Fountain of Youth," and claimed the treatments made patients "younger and smarter," according to the Justice Department.

Insurers only reimburse for ECP treatments for patients who suffer from disabling angina. To game the system, Dr. Shah told employees to indicate on billing sheets that every patient who received ECP treatments suffered from disabling angina, even though many of the patients never experienced this condition.

Dr. Shah submitted fraudulent claims to insurers for ECP treatments for some patients he never met, even though insurers require a physician to supervise the treatment. He also double-billed insurers by using a bundled ECP code, according to the Justice Department.

Between 2008 and 2013, Dr. Shah submitted more than $13 million in ECP-related claims to private and government payers, of which the insurers paid roughly $3.5 million.

Dr. Shah's sentencing hearing is scheduled for Nov. 6. He faces up to 10 years in prison, according to the Justice Department.

More articles on legal and regulatory issues:

10 latest healthcare industry lawsuits, settlements
DOJ pursues slew of EHR cases: 5 things to know
SSM Health strikes $60M deal in pension plan case



Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars