$48M 'Doctor Chasing' Fraud Leads To Prison For Westchester Man

PELHAM MANOR, NY — The leader at the center of a nearly $50 million federal health care fraud case was sentenced for his role in the complicated scheme to defraud Medicare.

Jay Clayton, the U.S. Attorney for the Southern District of New York, announced on Tuesday that 44-year-old Manishkumar Patel, of Pelham Manor, was sentenced to 14 months in prison for defrauding Medicare. He previously pleaded guilty to conspiring to commit health care fraud, wire fraud, and violating the Anti-Kickback Statute.

"As he previously admitted, Manishkumar Patel bilked Medicare for nearly $50 million," Clayton said. "Frauds on our Medicare system increase costs for all Americans, and worse yet, potentially restrict access to those in need of critical healthcare. Patel's 14 month sentence in federal prison sends an important deterrent message to those who would seek to bilk our Medicare system."

SEE ALSO:

• Westchester Mastermind Behind $50M 'Doctor Chasing' Fraud Admits Guilt
• Westchester Resident Accused Of Health Care Fraud And Kickback Scheme

According to court documents, between 2019 and 2022, Patel and an accused co-conspirator fraudulently sold prescriptions and doctors' orders for durable medical equipment, pharmaceuticals, and laboratory tests to durable medical equipment suppliers, pharmacies, and laboratories.

Patel obtained the scripts from call centers that called Medicare beneficiaries and asked them a few basic questions designed to justify a script that would be reimbursed by Medicare. He then turned the information from those calls into scripts by arranging short telemedicine appointments with the beneficiaries — a practice referred to as "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, the scheme soon started to unravel. Many beneficiaries rejected the items they were sent by the Medicare providers, 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 those Medicare providers entered into sham contracts for generic marketing services at flat rates in an attempt to hide their illegal kickback scheme.

Prosecutors said Patel was a leader of the scheme, which resulted in losses to Medicare of around $48 million.

In addition to the prison term, Patel was sentenced to one year of home detention. He was also ordered to pay $48,150,692.49 in restitution to the U.S. Centers for Medicare and Medicaid Services, and to forfeit $6,839,900.

Clayton praised the work of the U.S. Department of Health and Human Services, Office of Inspector General.

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