Manishkumar Patel, the leader of a $50 million health care fraud scheme involving the sale of fraudulent prescriptions for medical supplies to suppliers, pharmacies, and laboratories, recently pled guilty for his involvement in the scheme. Patel 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.
Patel and an unnamed co-conspirator fraudulently sold prescriptions and doctors’ orders for durable medical equipment (DME), pharmaceuticals, and lab tests to DME suppliers, pharmacies, and laboratories, from at least in or about 2019 through at least in or about 2022. In most cases, Patel would allegedly obtain the prescriptions and orders from call centers that called Medicare beneficiaries and asked questions designed to justify a prescription that would be reimbursed by Medicare. These individuals would often be referred to as “leads.” Patel controlled at least one of the call centers at issue, and paid other call centers for the leads.
Patel would then turn the information gleaned from those calls into prescriptions by arranging brief telemedicine appointments with the beneficiaries. Sometimes, the beneficiaries’ information was sent to a doctor who would sign the prescription without ever seeing the patient – and who were often unaware of what they were signing. In still other cases, the doctor’s signature was forged on the prescription. In most cases, the signed prescriptions did not represent a doctor’s informed judgment that the prescription was medically necessary. Patel would then sell the prescriptions to Medicare Providers, who filled the orders and billed Medicare for the item.
However, because the prescriptions were obtained through fraudulent means, many of the beneficiaries objected to receiving the items they were sent by Medicare providers. Additionally, because Patel and his co-conspirator turned the leads into prescriptions in illegitimate ways, doctors often threatened to report Patel for fraud.
The Medicare Providers paid Patel for the prescriptions, in violation of the Anti-Kickback Statute. The Medicare Providers and Patel entered into sham contracts for marketing services at a flat rate, in an attempt to conceal the kickback scheme. The scheme resulted in losses to Medicare of nearly $50 million.
In addition to the guilty plea, Patel was ordered to pay $48,150,692.49 in restitution to the Centers for Medicare and Medicaid Services (CMS) and forfeit an additional $6,839,900.
Each of the counts that Patel pled guilty to carry a maximum sentence of five years in prison. The indictment for Patel can be found here.