Leader Of $50 Million Health Care Fraud Pleads Guilty

Damian Williams, the United States Attorney for the Southern District of New York, announced that MANISHKUMAR PATEL pled guilty today in connection with a $50 million health care fraud and kickback scheme involving the sale of fraudulent prescriptions for durable medical equipment, among other medical supplies, to suppliers, pharmacies, and laboratories who obtained payment for those fraudulent prescriptions from Medicare.  PATEL pled guilty before U.S. Magistrate Judge Ona T. Wang and is scheduled to be sentenced on July 26, 2024, at 10:00 a.m. before U.S. District Judge Lorna Schofield.

U.S. Attorney Damian Williams said: “Behind every dollar siphoned through fraud lies a patient denied rightful care.  Manishkumar Patel cost Medicare nearly $50 million in resources that could have been used to provide genuine care to those in need.  His guilty plea today is a step toward restoring integrity and trust in our health care system.”

According to the charging documents and other filings and statements made in court:

Between 2019 and 2022, PATEL and a co-conspirator (“CC-1”) fraudulently sold prescriptions and doctors’ orders for durable medical equipment, pharmaceuticals, and laboratory tests (collectively, “scripts”) to durable medical equipment suppliers, pharmacies, and laboratories (collectively, the “Medicare Providers”).

PATEL obtained the scripts from call centers that called Medicare beneficiaries and asked them perfunctory questions designed to justify a script that would be reimbursed by Medicare.  PATEL turned the information from those calls into scripts by arranging cursory telemedicine appointments with the beneficiaries — a practice called “doctor chasing,” in which the information was sent to a doctor who signed the script without seeing the patient and who was frequently unaware of what they were signing — and obtaining forged scripts.  PATEL then sold the scripts to Medicare Providers, which filled the orders and billed Medicare. 

Because the scripts were fraudulently obtained, many beneficiaries rejected the items they were sent by the Medicare Providers, many doctors threatened to report PATEL for fraud, and Medicare frequently refused to pay for the scripts.

The Medicare Providers made payments to PATEL for the scripts in violation of the Anti-Kickback Statue.  PATEL and the Medicare Providers entered into sham contracts for generic marketing services at flat rates in an attempt to conceal their illegal kickback scheme.

PATEL was a leader of the scheme, which resulted in losses to Medicare of nearly $50 million.

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PATEL, 44, of Pelham Manor, New York, pled guilty to one count of conspiracy to commit health care fraud, one count of wire fraud, and one count of violating the Anti-Kickback Statute, each of which carries a maximum sentence of five years in prison.  In addition, PATEL was ordered to pay $48,150,692.49 in restitution to the U.S. Centers for Medicare and Medicaid Services and forfeit $6,839,900.

The maximum potential sentences in this case are prescribed by Congress and are provided here for informational purposes only, as any sentencing of the defendant will be determined by a judge.

Mr. Williams praised the outstanding work of the Department of Health and Human Services, Office of Inspector General.

The case is being prosecuted by the Office’s Complex Frauds and Cybercrime Unit.  Assistant U.S. Attorney Kevin Mead is in charge of the prosecution.