Cardiologist found guilty of billing insurers $13M for needless angina treatments

An eight-day trial and two-hour jury deliberation has culminated in the conviction of Pennsylvania cardiologist Samirkumar J. Shah, who on June 14 was found guilty of two counts of healthcare fraud for falsely billing insurers for unnecessary angina treatments.

Shah, 56, of Fox Chapel, Pa., reportedly submitted fraudulent claims totaling upwards of $13 million to Highmark Blue Cross Blue Shield, UPMC Health Plan, Gateway Health Plan and Medicare and Medicaid between 2008 and 2013. During that five-year period, Shah billed the insurers for an outpatient treatment known as external counter pulsation, or ECP.

ECP, a noninvasive therapy for angina, involves the use of a specialized bed equipped with pressure cuffs. When affixed to a patient, the cuffs exert pressure on the lower extremities, encouraging increased blood flow to the heart. According to a DOJ notice, Shah purchased 25 beds and offered ECP to patients at more than 18 clinics across Western Pennsylvania, Ohio, New York and Florida.

Evidence presented at Shah’s trial revealed the physician advertised ECP as “the Fountain of Youth,” claiming it made patients younger and smarter and could treat ailments ranging from diabetes to hypertension to erectile dysfunction. Though many of his patients never reported feeling any kind of chest pain, Shah’s billing documents reflected that each of his patients experienced disabling angina.

U.S. Attorney Scott W. Brady said Shah received reimbursement checks in excess of $3.5 million for unnecessary ECP treatments, many of which occurred while neither Shah nor any other licensed physician was in the room. In one case, a patient undergoing unsupervised ECP experienced an adverse event and had to be rushed to the nearest hospital in an ambulance.

“Healthcare fraud threatens the safety and integrity of our entire healthcare system,” Brady said in a statement. “Doctors and medical professionals like Dr. Shah who issue false diagnoses, order unnecessary testing and fraudulently bill Medicare and Medicaid in effect steal from the most vulnerable in our community. Today’s jury verdict sends a clear message to those who would do the same: If you commit healthcare fraud, you will be prosecuted to the fullest extent of the law.”

Other evidence in Shah’s case suggested his patients were required to undergo certain diagnostic ultrasounds prior to ECP to rule out any dangerous blood clots, but Shah didn’t review any of that imagery before approving his patients for the therapy.

FBI Pittsburgh Special Agent in Charge Robert Jones said in the statement Shah’s actions went “against the medical ethics he was to uphold,” promising the FBI would continue to “allocate a significant amount of expert resources to investigate these crimes and hold those defrauding the system accountable.”

U.S. District Judge David S. Cercone scheduled Shah’s sentencing for Nov. 6 of this year. The cardiologist is facing a maximum sentence of 10 years in prison, a fine of $250,000, or both.