Detroit-Area Physical Therapist and Home Health Agency Owner Pleads Guilty to Medicare Fraud Scheme

doc-thumbWASHINGTON, D.C. (August 15) – On August 14, 2013, a Detroit-area physical therapist who was also an owner of a home health agency entered a guilty plea to one count of conspiracy to commit health care fraud in the U.S. District Court for the Eastern District of Michigan regarding his role in a $22 million home health care fraud scheme. Bhagat faces a maximum penalty of 10 years in prison and a $250,000 fine. Sentencing is scheduled for November 12, 2013.
According to information contained in plea documents, Bhagat admitted that over about a year and a half period beginning May 2009, he conspired with others to commit health care fraud through billing Medicare for home health care services that were either not actually rendered or not medically necessary.
Bhagat admitted that his co-conspirators paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare. Bhagat and his cohorts then created phony therapy files to falsely document physical therapy services were provided to Medicare beneficiaries, when in fact no such services had ever been provided and if provided were not medically necessary in the first place.
Bhagat signed fictitious documents including physical therapy evaluations, supervisory patient visits, and patient discharge forms to indicate that he and others had provided physical therapy services to Medicare beneficiaries, when in fact they had not. Bhagat admitted to knowing that the documents he created would be used to support false claims submitted to Medicare. Bhagat submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $4,767,359.03.
Section 2B1.1 is the guideline section of the federal sentencing guidelines to consult for determining the correct sentencing range. Section 2B1.1 calls for the calculation to start a base offense level 6. Because the actual loss is alleged to be $4.76, an additional 18 level increase applies. There is also an enhancement under §2B1.1 for health care fraud, which says, “If (A) the defendant was convicted of a Federal health care offense involving a Government health care program; and (B) the loss under subsection (b)(1) to the Government health care program was (i) more than $1,000,000, increase by 2 levels[.]” It is not certain whether Bhagat will role enhancement; however, it looks like one is coming. Under §3B1.1(b) or (c) it looks like Bhagat should be getting either a 2, 3 or 4 level increase. The government is seeking a sentence between 70-87 months behind bars. Bhagat is seeking a sentence between 63 – 78 months.
If you or someone you know has been accused of medicare fraud, contact attorney Robert Malove. He can help.

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