Texas NP gets 20-year sentence, ordered to pay $52M for fraud using physician IDs

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A nurse practitioner from Texas was sentenced May 25 to 20 years in prison for his role in orchestrating a scheme to defraud Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana and Cigna.

Trivikram Reddy, 39, also was ordered to repay $52 million in restitution for his role in the conspiracy. 

Prosecutors said Mr. Reddy created fraudulent patient bills by using the provider numbers of six physicians as the treating physicians on the claims, even though they did not perform the services.

In June 2019, federal agents investigated one of Mr. Reddy's medical clinics and found his staff manufacturing medical records. After the investigation, Mr. Reddy closed the clinic and terminated his business entity.

A few days after Mr. Reddy closed the clinic he made the first of several wire transfers, which totaled more than $55 million, prosecutors said. An analysis on the wire transfer tied the money to the fraudulent healthcare claims. 

Federal agents also around the same time period requested medical records to justify Medicare claims paid between January 2014 and June 2019, and Mr. Reddy and his staff allegedly spent the four months manufacturing fake medical records to turn over to authorities.

Mr. Reddy pleaded guilty to wire fraud in October 2020. 

"When nurse practitioner Trivikram Reddy stole the identities of physicians to defraud Medicare and other insurers to enrich himself, he violated the basic trust that the public extends to healthcare professionals," said Miranda Bennett of the HHS Office of Inspector General Dallas regional office. "Today’s sentence sends a message to corrupt medical professionals that law enforcement will do everything possible to root out all forms of waste, fraud and abuse in our federal healthcare programs."

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