Doctor Sentenced To 20 Years For $5.7M In Overbilling

Friday, December 18, 2015

Ohio Cardiologist Sentenced to 20 Years in Prison for Overbilling Medicare and Others of $5.7 Million for Unnecessary Procedures

A Westlake, Ohio, cardiologist was sentenced to 20 years in prison for performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $29 million, law enforcement officials said.

Dr. Harold Persaud, 56, was convicted earlier this year of one count of health care fraud, 13 counts of making false statements and one count of engaging in monetary transactions in property derived from criminal activity.

"This defendant used his medical license as a license to steal," said First Assistant U.S. Attorney Carole S. Rendon. "He inflated Medicare billings, falsified cardiac care records and performing needless and sometimes invasive tests and procedures. This prison sentence is well deserved."

"Dr. Persaud violated the sacred trust between doctor and patient by ordering unnecessary tests, procedures and surgeries to line his pockets," said Special Agent in Charge Stephen D. Anthony of the FBI's Cleveland Office. "He ripped off taxpayers and put patients' lives at risk."

"Dr. Persaud's systematic use of medically unnecessary tests and procedures, falsification of patient records and submission of false billings to health care insurers added up to a toxic mixture of fraud at the expense of patient safety and well-being and taxpayer dollars," said Special Agent in Charge Lamont Pugh III of the U.S. Department of Health & Human Services, Office of Inspector General - Chicago Region."The OIG, along with our law enforcement partners, will continue to identify, investigate and seek the criminal prosecution of those who choose to exploit federally funded health care programs and the patients these programs serve."

Persaud had a private medical practice at 29099 Health Campus Drive in Westlake and had hospital privileges at Fairview Hospital, St. John's Medical Center and Southwest General Hospital, according to court documents and trial testimony.

Persaud devised a scheme to defraud and obtain money from Medicare and other insurers. The scheme took place between 2006 and 2012. According to court documents and trial testimony, his activities in furtherance of the scheme included:

Persaud selected the billing code for each customer submitted to Medicare and private insurers and used codes that reflected a service that was more costly than that which was actually performed;

Persaud performed nuclear stress tests on patients that were not medically necessary;

He knowingly recorded false results of patients' nuclear stress tests to justify cardiac catheterization procedures that were not medically necessary;

Persaud performed cardiac catheterizations on patients at the hospitals and falsely recorded the existence and extent of lesions (blockage) observed during the procedures;

He recorded false symptoms in patient records to justify testing and procedures on patients;

Persaud inserted cardiac stents in patients who did not have 70 percent or more blockage in the vessel that he stented and who did not have symptoms of blockage;

He placed a stent in a stenosed artery that already had a functioning bypass, thus providing no medical benefit and increasing the risk of harm to the patient;

He improperly referred patients for coronary artery bypass surgery when there was no medical necessity for such surgery, which benefitted Persaud by increasing the amount of follow-up testing he could perform and bill to Medicare and private insurers;

Persaud performed medically unnecessary stent procedures, aortograms, renal angiograms and other procedures and tests.

As a result of this scheme, Persaud overbilled and caused the overbilling of Medicare and private insurers in the amount of approximately $29 million, of which Medicare and the private insurers paid approximately $5.7 million, according to court records.

A hearing is scheduled for Jan. 27, 2016, to determine restitution.

This case is being prosecuted by Assistant U.S. Attorneys Michael L. Collyer and Chelsea Rice following an investigation by the FBI and the U.S. Department of Health and Human Services - Office of Inspector General

USAO - Ohio, Northern (http://www.justice.gov/usao-ndoh)

Updated December 18, 2015