Cardiologist Sentenced To 20 Years Following Conviction For Fraud In Billing Medicare And Private Insurers For Medically Unnecessary Tests And Cardiac Procedures
By: Alexander M. Owens
An Ohio cardiologist who was convicted by a jury of engaging in a $29 million dollar healthcare fraud scheme was sentenced on December 18, 2015 to 20 years in prison. Harold Persaud, M.D. had run his own medical practice and also had hospital privileges at three Ohio hospitals. The government alleged and presented evidence that over approximately six years, from 2006 to 2012, Persaud not only used erroneous, more expensive billing codes to bilk insurers into overcompensating his practice, but also subjected his patients to unnecessary diagnostic tests and procedures.
The Government’s case emphasized the fact that Persaud’s scheme was both well-calculated to lead to overpayment, and placed the health of his patients in jeopardy. For example, in some instances, Persaud reported false test results in order to justify the placement of cardiac stents in patients, resulting in medically unnecessary invasive procedures. Persaud also referred patients for unnecessary coronary bypass surgeries, which allowed him to then perform expensive follow-up testing. While the government placed the intended loss of Persaud’s scheme at $29 million, the evidence indicated that Persaud personally realized approximately $5.7 million.
The FBI started its investigation in 2012. The three hospitals where Persaud provided care and performed procedures started their own investigations into the propriety and necessity of Persaud’s procedures. The government’s investigation resulted in a multi-count indictment, to which Dr. Persaud maintained his innocence through trial.
Following a four week jury trial, Persaud was found guilty of one count of health care fraud, one count of engaging in monetary transactions with property derived from criminal activity, and 13 counts of making false statements. At his sentencing hearing Persaud did not embrace contrition. Rather, in an over 30 minute dialogue, Persaud asserted that he could explain why he performed each of the procedures. A restitution hearing is scheduled for January 2016. Persaud also faces civil suits arising from his fraudulent scheme.
U.S. District Judge Donald Nugent’s twenty year sentence demonstrates the significant consequences for health care practitioners who cannot appropriately and adequately demonstrate the medical necessity for medical procedures, particularly where the fraudulent conduct does not simply result in higher reimbursement, but unnecessarily jeopardizes the health and safety of patients.