Source: 13 News Now Feature Photo Source: Unsplash, Dimitri Houtteman
The scheme involved overbilling healthcare benefit programs by seeing patients for only five to 10 minutes but then billing them for 41 to 63 minutes on average.
VIRGINIA BEACH, Va. — A Virginia Beach doctor was sentenced on Thursday to over two years in prison for defrauding Medicare, Medicaid, and Tricare, and other health care benefits programs out of hundreds of thousands of dollars.
The Department of Justice said 64-year-old Udaya K. Shetty also agreed to pay over $1 million to settle related civil claims on top of the prison sentence.
According to court documents, Shetty was a licensed psychiatrist practicing medicine at his practice, Behavioral & Neuropsychiatric Group. Starting in 2013, he created a scheme where he could overbill healthcare benefit programs by seeing patients for only five to 10 minutes but then billing for services that were on average 41 to 63 minutes long.
Shetty instructed his staff to often double, triple, or even quadruple book appointment times. The fraud started to become apparent when investigators discovered that on dozens of instances Shetty would need more than 24 hours a day of working to perform the services for which he billed.
In 2017, Shetty closed his practice and joined another psychiatric practice, Quietly Radiant Psychiatric Services. While there, Shetty and one of his former employees, Mary Otto, engaged in a similar scheme. Although other Quietly Radiant staff members were responsible for billing, Shetty directed Otto to access the billing system and change all of his billing data to a higher billing rate.
Otto complied and changed the data without the knowledge of Quietly Radiant’s staff. As a result of their actions, Shetty and Otto defrauded various healthcare benefit programs of more than $450,000.
Otto pled guilty for her role in the scheme and was sentenced to 15 months in prison on January 10.
In regards to the civil settlement, Shetty agreed to pay $1,078,000 to the United States and the Commonwealth of Virginia to resolve his liability under the False Claims Act and the Virginia Fraud Against Taxpayers Act for submitting or causing the submission of false claims to the Medicare, Medicaid, and TRICARE programs.
Would you recognize health care fraud when you see it? What does it look like? What are the affects of health care fraud taxpayers, patients and the community?
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