Westchester Resident Accused Of Health Care Fraud And Kickback Scheme

PELHAM MANOR, NY — A Westchester County man is accused of running a Medicare fraud scheme that collected at least $10 million in spite of constant snags.

Manishkumar Patel was arrested Tuesday in Pelham Manor on a five-count indictment, Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General, announced.

"As alleged, Manishkumar Patel ran a scheme to get rich by generating fraudulent prescriptions used to bill Medicare for millions of dollars in unnecessary healthcare expenses," Williams said. "Today’s charges send a message: our Office and our law enforcement partners are dedicated to holding accountable anyone who tries to rip off critical healthcare programs like Medicare."

As alleged in the indictment, between 2019 and 2022, Patel and a co-conspirator fraudulently sold prescriptions and doctors’ orders for durable medical equipment, pharmaceuticals, and laboratory tests (collectively, "scripts") to durable medical equipment suppliers, pharmacies, and laboratories.

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. He then, prosecutors alleged, turned the information from those calls into scripts: He either arranged cursory telemedicine appointments with the beneficiaries; used 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; or obtained forged scripts.

They said Patel then sold the scripts to various providers that filled the orders and billed Medicare.

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

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

"Certain violations of the Anti-Kickback Statute can result in the inducement of medically unnecessary durable medical equipment, medications, and laboratory tests, which can affect the availability of services for others and drive up the cost of health care for everyone," HHS-OIG Special Agent in Charge Naomi Gruchacz said. "Individuals and entities that participate in the federal health care system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients."

PATEL, 44, is charged with:

• conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison
• health care fraud, which carries a maximum sentence of 20 years in prison
• wire fraud, which carries a maximum sentence of 20 years in prison
• conspiracy to violate the Anti-Kickback Statute, which carries a maximum sentence of five years in prison
• violation of the Anti-Kickback Statute, which carries a maximum sentence of five years in prison.

The maximum potential sentences are prescribed by Congress and are provided here for informational purposes only, as any sentencing of the defendant will be determined by a judge. The charges contained in the indictment are merely accusations, and the defendant is presumed innocent unless and until proven guilty.

Williams praised the outstanding work of HHS-OIG. Assistant U.S. Attorney Kevin Mead in the Office’s Complex Frauds and Cybercrime Unit leads the prosecution. The case is assigned to U.S. District Judge Schofield.