The Least You Can Do is See Patients: New Jersey Physician Sentenced to Four Years in Prison for Medicare and Medicaid Fraud

Paul Mathieu, MD, of New Jersey, was recently sentenced to four years in prison for his role in a scheme to defraud Medicare and Medicaid of $30 Million. He was convicted in May on charges of health care fraud, wire fraud, and mail fraud, conspiracy to commit the same, and conspiracy to make false statements in connection with a federal health program. Between 2007 and 2013, Mathieu posed as the owner of several New York clinics, and falsely claimed that he treated and examined thousands of patients.

According to US Department of Justice (“DOJ”) allegations, between 2007 and 2013, Mathieu fraudulently posed as the owner of three Brooklyn medical clinics. The three clinics were actually owned by Aleksandr Burman, a co-conspirator in the case. Burman is not a medical professional and thus could not legally own the clinics, as a New York law requires that medical clinics be owned and operated by medical professionals.

During the relevant time period, Mathieu billed Medicare and New York state Medicaid approximately $30 million for services and supplies that were medically unnecessary, not provided, or both. In addition, for the last three-and-a-half years of the period, Mathieu “directly participated” in the fraudulent billing practices during weekly visits to the clinics where he would “sign stacks of false and fraudulent charts, and issue referrals for expensive additional testing, occupational therapy, and physical therapy,” including for physical therapy provided by Hatem Behiry, another co-defendant in the case. The DOJ added that during these clinic visits “Mathieu saw no patients at all, simply falsifying enormous stacks of phony medical records falsely stating that he had seen and treated such patients.” The DOJ also alleged that many of the clinic patients were receiving kickbacks for coming to the clinic.

In addition to his activities at the clinics, the DOJ alleged that Mathieu wrote unnecessary prescriptions for various other medical supplies, which were filled at a medical supply company owned by Burman’s wife. Eventually, Medicare stopped paying the clinics’ claims and the clinics were shut down, but Mathieu continued to write these medically unnecessary prescriptions even after that.

Mathieu was facing potentially decades in prison and over one million dollars in fines. Mathieu is the tenth defendant, and third physician, to be sentenced in this and a related case. In addition to his prison sentence, the judge ordered Mathieu to pay restitution and forfeiture.

In response to the sentence, US Attorney Geoffrey Berman noted that “[t]hese taxpayer-funded programs are designed to provide essential medical services to the elderly and the needy, not to enrich corrupt doctors and other fraudsters. Paul Mathieu’s sentence sends a clear message that those who cheat Medicare and Medicaid will be held accountable.”