ATLANTA (CBS46) – A pair of Atlanta men will spend at least six years in federal prison for their roles in a healthcare fraud scheme that also involved aggravated identity theft.
According to the U.S. Attorney’s Office for the Northern District of Georgia, Shailesh Kothari and Timothy McMenamin both pled guilty to three charges each late last year. The US Attorney’s Office said the scheme involved allergy and other testing. Federal authorities said they submitted more than 4,500 fraudulent claims seeking more than $8.5 million in insurance payments.
The convicts would hire market research companies across the U.S. to recruit patients to participate in allergy testing. Patients were told there was no out-of-pocket costs to the testing. Patients were tested for allergies regardless of presence of symptoms and without any determination of medical need.
The U.S. Attorney’s Office said during the allergy testing, patients’ blood was drawn supposedly to be sent to a lab for allergy and other testing. The company Kothari and McMenamin ran, Primera Medical Group, also billed for blood tests that never ran. Federal officials said hundreds of blood tests were never completed, but were billed for by Primera.
According to the USAO, if an insurance company requested medial records to support the billed services; the duo would create false lab reports to submit to the insurance company. The phony lab reports would be sent to then support the fraudulent billing. Federal authorities also said the group also sent phony results to patients.
Kothari was sentenced to 81 months in prison followed by three years of supervised release and fined more than $1.5 million. McMenamin was sentenced to 94 months in prison with three years of supervised release and also fined more than $1.5 million.