Friday, July 15, 2016

A study in Contrast - Compare USA to India

Indian-American couple ordered to pay $7.75 million for healthcare fraud

WASHINGTON: An Indian-American couple, who owned a mobile diagnostic testing company in New Jersey, has been ordered by a US court to pay USD 7.75 million for committing a multi-million health care fraud.

Kirtish N Patel and Nita K Patel, both aged 53, had earlier pleaded guilty to healthcare fraud.

The government's civil complaint had alleged that they created fraudulent diagnostic test reports, forged physician signatures on these reports and then billed Medicare for the fraudulent reports.

They also billed Medicare for neurological tests that they conducted without the required physician supervision, the Justice Department said.

The lawsuit was filed under whistleblower, provisions of the False Claims Act, which allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery.

The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case.

The whistleblower who brought the misconduct to the government's attention will receive 15 to 25 per cent of the more than USD 7.7 million recovered by the government.

According to the documents filed in the case and statements made in the court from 2006 through June 2014, Nita and Kirtish owned and operated Biosound Medical Services Inc and Heart Solutions in New Jersey, which were mobile diagnostic companies and approved medicare providers.

As per court documents, Biosound technicians would travel to the office of a primary care physician in the New York and New Jersey area to conduct diagnostic testing.

Biosound was responsible for sending the tests to a reading physician, an appropriate specialist who would interpret the results.

"After the reading physician prepared a report, Biosound was responsible for providing it to the referring physician.

Biosound was paid millions of dollars by Medicare and other payors for the diagnostic testing, the reading physician's interpretation of the results and the reports, the prosecutors said.

Kirtish admitted to fraudulently interpreting and writing diagnostic reports produced by Biosound despite having no medical license and knowing that the reports would be used by the referring physicians to make important patient treatment decisions.

Nita assisted her husband in forging physician signatures on the fraudulently produced reports to make them appear legitimate.

The couple admitted falsely representing to Medicare that the neurological testing performed by Biosound was being supervised by a licensed neurologist, the Justice Department said.

According to reports, more than half of the diagnostic reports generated by Biosound between October 2008 and June 2014 were never actually reviewed or interpreted by a physician.

Nita and Kirtish were paid more than USD 4,386,133.75 by Medicare and private insurance companies for the fraudulent reports, which they used for personal expenses, including multiple residences and luxury vehicles, it said

Kidney racket busted in Mumbai hospital, 4 arrested

MUMBAI: Mumbai police arrested four persons in connection with a kidney racket busted at Hiranandani hospital today. Acting on a tip-off, the police team carried out a raid and caught the agent identified as Vijendra Visen and three others.

The hospital staff and the management officials are being questioned. Joint Commissioner of Police (Law and Order) Deven Bharti confirmed to TOI about the racket bust and said probe is still on.

Deputy Commissioner of Police (Zone X) Vinayak Deshmukh said the police team inspected the hospital on a complaint by a social worker Mahesh Tanna.

"On certain reliable information we approached Hiranandani hospital and informed the authority that the kidney transplant operation of the patient Brijkishor Jaiswal be stopped as the donor is not his wife and documents submitted for kidney transfer are forged," said Deshmukh. Deshmukh said accordingly the operation was stopped.

Mumbai police spokesperson DCP Ashok Dudhe said a case has been registered and four persons taken into custody.

TOI attempted to speak with the hospital doctors and management staff but in vain.

The above is from
I have put the above articles together to present a study in contrast.
In the USA, the Indian couple (ironically) have been convicted and made to pay a fine of $ 7.75 million.
In India, a similar kidney racket has been uncovered but after a time all will be forgotten as bribe will change hands.
In the USA, the whistle blower will be rewarded by being paid 15 to 25% of the collection.
In India, the whistle blower will lose his life.
A convicted doctor will merrily go on as we have seen in the case of Ketan Desai.

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