Boston Doctor Pleads Guilty, Sentenced to Jail and Ordered to Pay $9.3 Million for Running Medicaid False Billing Scheme


A Boston doctor, whose addiction clinics employed around 370 people, including 30 physicians, has been sentenced to 11 months in prison and ordered to pay $9.3m (£6.1m; €8.6m) in restitution over a Medicaid fraud scheme based on urine testing of recovering addicts. He has also surrendered his medical license.

Dr. Punyamurtula Kishore, 64, an Indian citizen living in the United States since 1977, pleaded guilty, along with his company Preventive Medicine Associates, Inc. (PMA), to a complex kickback scheme that cheated millions of dollars from MassHealth, the Medicaid administrator for Massachusetts.              

The charges were Medicaid Kickbacks (8 counts), Medicaid False Claims (19 counts) and Larceny over $250 (11 counts). Dr. Kishore pleaded guilty to one count of Larceny over $250.

“Dr. Kishore orchestrated a complex kickback scheme to funnel a lucrative drug screening business to his laboratories and then billed taxpayers millions of dollars for those services,” AG Healey said. “This case exhibited blatant theft of state funds that were supposed to go toward care for some of our most vulnerable residents. This is fraud that undermines the integrity of our health care system.”

Superior Court Judge Janet Sanders sentenced Kishore to 360 days in the House of Correction, with 11 months to serve and the balance suspended for 10 years. As a condition to his sentence, Kishore has also agreed to surrender his medical license. Judge Sanders also ordered Kishore and PMA to pay, jointly and severally, a total of $9.3 million in restitution.

Dr. Kishore previously owned and managed PMA, a network of 29 medical branches throughout Massachusetts, including physician office laboratories and one independent clinical laboratory. Based on the AG’s investigation, Dr. Kishore used bribes, or kickbacks, to induce sober house owners to send their residents’ urine drug screening business to his laboratories for testing. Residents were typically screened three times per week.

In September 2011, Dr. Kishore and PMA were indicted, and individually charged with Medicaid Kickbacks (8 counts), and Medicaid False Claims (8 counts). In November 2013, Dr. Kishore and PMA were indicted on additional charges of Medicaid False Claims (11 counts) and Larceny over $250 (11 counts) for billing MassHealth for millions of dollars in drug screens using the names of PMA physicians and nurse practitioners who were not actually treating the patients or determining the drug screens to be medically necessary. State regulations require that the services must be medically necessary and the provider must be physically present and actively involved in the treatment of the member. 

Source www.massgov.com 

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