NEWARK, N.J. - A Morris County, New Jersey, man pleaded guilty today to health care fraud in a scheme to bill for diagnostic testing services he did not render and to enable a cardiologist to evade the Medicare program’s pre-payment review of his claims, U.S. Attorney Paul J. Fishman announced.
Vijay Patel, 57, of Parsippany, New Jersey, pleaded guilty before U.S. District Judge Esther Salas in Newark federal court to an information charging him with one count of health care fraud.
According to documents filed in this case and statements made in court:
From 2009 to the present, Patel has been the owner of a diagnostic testing facility in Parsippany called Mobile Diagnostic Testing of NJ LLC (Mobile Diagnostic). He was also a participant in Medicare.
Patel had an associate identified as “S.A.," who was a cardiologist and also a participant in the Medicare program. From around 2009 through 2012, S.A.’s Medicare contractor had placed him on so-called “pre-payment review," which was initiated to ensure that S.A. was submitting claims within established rules and regulations and consistent with appropriate medical decision-making, and which required S.A. to submit medical and other documentation to support the services being billed to Medicare. Under pre-payment review, claims for reimbursement that did not have the documentation necessary to support the services being billed are rejected by the Medicare contractor.
From November 2009 through October 2012, Patel and S.A. engaged in a scheme to defraud Medicare whereby S.A. paid Patel substantial sums of money to enable S.A. to evade Medicare’s prepayment review. Patel admitted in court that he submitted claims to Medicare for diagnostic testing services that S.A. had performed as if Mobile Diagnostic had performed the services instead of S.A. Once Medicare paid Patel and Mobile Diagnostic for diagnostic testing services that S.A. had actually provided, Patel then transferred a portion of the payment to S.A. and kept a substantial portion for himself.
The charge to which Patel pleaded guilty carries a maximum potential penalty of 10 years in prison and a maximum $250,000 fine, or twice the gain or loss caused by the offense. Sentencing is scheduled for March 23, 2015.
U.S. Attorney Fishman credited special agents of the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Tom O’Donnell, for the investigation leading to the guilty plea.
The government is represented by Assistant U.S. Attorney Scott B. McBride, Deputy Chief of the U.S. Attorney’s Office’s Economic Crimes Unit.
14-443 Defense counsel: Richard M. Asche Esq., New York
Source: U.S. Department of Justice, Office of the United States Attorneys
