The man faked a alcohol use disorder in order to qualify for admission into the RDAP.
An Indian-American man was sentenced to 12 years in prison and ordered to pay nearly one million dollars in fine for health care fraud and aggravated identity theft.
Babubhai Bhurabhai Rathod of Michigan had pleaded guilty to both charges in August 2018, US Attorney Andrew Birge said. US District Judge Janet Neff also ordered Rathod to pay over USD 939,000 in restitution to federal health insurance programmes Medicare and Medicaid.
In 2013, Rathod was sentenced to four years in prison-and was further excluded from participating in Medicare and Medicaid-after being convicted of paying practitioners illegal kickbacks in exchange for patient referrals to his health care companies.
While in prison, Rathod faked a drug and alcohol use disorder in order to qualify for admission into the Residential Drug Abuse Programme (RDAP), a programme that allows eligible inmates to lessen the amount of time that they would otherwise serve.
He completed RDAP and was released early from custody. Within days of his release in 2016, he began violating his exclusion and supervised release conditions by operating four health care providers across the State of Michigan - Advanced Medical Services (d/b/a Advanced Sleep Diagnostics of Michigan); Sleep Diagnostics of Michigan; EZ Sleep Supplies; and Paramount Home Care.
To conceal his ownership of these providers from Medicare and Medicaid, Rathod used a variety of aliases, straw owners, and shell holding companies that were registered to other people.
His scheme netted nearly a million dollars in Medicare and Medicaid reimbursements to which his providers were not entitled.
As part of his scheme, Rathod used the name, address, date of birth, Social Security Number, and driver's license of a physician colleague to obtain working capital loans for Advanced Medical Services.
He also used the physician's identity, without the physician''s knowledge, to personally guarantee those loans. When Advanced Medical Services defaulted on one of these loans, a state-court judgment was entered against the physician-without the physician's knowledge-and the physician''s bank account was frozen.
At sentencing, Judge Neff noted the "breadth, scope, and depth" of Rathod's fraud and remarked that he was "stealing from the government. That is what this is." Judge Neff described Rathod as both "a man for whom the truth is a stranger" and a naturalised citizen who has "taken advantage of opportunities available in this country to steal from it."
"The resources it took to unravel Mr Rathod's elaborate scheme reflects our commitment to holding accountable those who would violate their federal programme restrictions," Mr Birge said.
Special Agent in Charge, US Department of Health and Human Services, Office of Inspector General - Chicago Region, Lamont Pugh said Rathod intentionally and recklessly tried to circumvent his 20-year exclusion in an attempt to line his pockets with vital taxpayer dollars.