Insurance fraud lands Chicago cardiologist behind bars

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The U.S. District Court for the Northern District of Illinois sentenced Sushil Sheth, MD, a Chicago cardiologist, to five years in prison for pilfering $13 million from Medicare and 30 other healthcare insurance plans over the past five years, after he submitted 14,800 false claims for the reimbursement for high-level cardiac services, which he never performed.

According to the U.S. Attorney’s Office, Sheth falsely reported patient cases and claims to Medicare and other insurance programs to receive millions of dollars for patient cases he never treated. Sheth admitted the estimated $13 million fraud between January 2002 and July 2007, acquiring approximately $8.3 million from Medicare and $5 million from public and private health insurance programs.

U.S. District Judge Rebecca Pallmeyer sentenced Sheth to a 60-month prison term, which he will begin to serve in two months. According to the charges, Sheth abused his hospital privileges and access at three hospitals to obtain patient information without their consent and then hired individuals to bill Medicare and other providers for cardiac procedures he never performed.

In July 2007, the feds searched Sheth’s home and found more than 600 uncashed checks totaling $6.7 million from various insurers.

Last year, Sheth pleaded guilty to one count of healthcare fraud after he was charged in January 2009. Sheth was ordered to pay restitution totaling $13 million. Authorities said that Sheth used the money to purchase mansion property in Arizona, automobiles and to invest in various venture capital endeavors.

Sheth agreed to forfeit his property the government seized from him, these funds totaled to more than $11.3 million.

“Healthcare fraud is one of the highest priorities of federal law enforcement. We will make every effort to recover any fraudulently obtained funds and to ensure that dishonest physicians and other medical providers do not profit from cheating Medicare and private insurers,” said Patrick J. Fitzgerald, U.S. Attorney for the Northern District of Illinois.