Jail term for Indian American nurse practitioner over $52m healthcare fraud

AN Indian American nurse practitioner has been sentenced to 20 years in jail over his role in a healthcare fraud scheme in the US.

Trivikram Reddy, 39, was also ordered to repay over $52 million in restitution for his role in the scheme.

Reddy pleaded guilty to conspiracy to commit wire fraud in October 2020, according to acting US Attorney for the northern district of Texas Prerak Shah.

A licensed nurse practitioner, Reddy devised a scheme to defraud firms such as Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana and Cigna, and was sentenced on May 25.

Reddy operated three medical clinics-Waxahachie Medical, Texas Care Clinics and Vcare Health Service.

According to Prosecutors, Reddy created fraudulent patient bills by using the provider numbers of six physicians as the treating physicians on the claims, even though they did not perform the services.

In June 2019, federal agents investigated one of Reddy's medical clinics and found his staff fabricating medical records. Following the investigation, he terminated his business.

A few days after the closure of the clinic he made the first of several wire transfers, which totalled more than $55m, prosecutors said.

Federal agents requested medical records to justify Medicare claims paid between January 2014 and June 2019. Hence, Reddy and his staff allegedly spent the four months manufacturing fake medical records to submit to authorities.

"When nurse practitioner Reddy stole the identities of physicians to defraud Medicare and other insurers to enrich himself, he violated the basic trust that the public extends to healthcare professionals," said Miranda Bennett of the HHS Office of Inspector General Dallas regional office.

"The sentence sends a message to corrupt medical professionals that law enforcement will do everything possible to root out all forms of waste, fraud and abuse in our federal healthcare programmes."