East Franklin doctor guilty in $13 million ‘fountain of youth’ health fraud scheme | TribLIVE.com
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Natasha Lindstrom

A former East Franklin doctor is guilty of plotting to defraud patients and insurers out of more than $13 million in a so-called “fountain of youth” medical treatment scheme, a jury found Friday.

Dr. Samirkumar J. Shah, 56, a cardiologist who also has ties to Kittanning and Fox Chapel, was convicted on two counts of federal health care fraud, U.S. Attorney Scott W. Brady said.

Jurors deliberated for nearly two hours following an eight-day trial at the federal courthouse in Pittsburgh.

Brady said their guilty verdict should send a message: “If you commit health care fraud, you will be prosecuted to the fullest extent of the law.”

“Doctors and medical professionals like Dr. Shah, who issue false diagnoses, order unnecessary testing and fraudulently bill Medicare and Medicaid, in effect steal from the most vulnerable in our community,” Brady said in a statement.

How the scheme worked

Between 2008 and 2013, Shah submitted fraudulent insurance claims to Medicare, Medicaid, UPMC, Highmark and Gateway health plans for an outpatient treatment called External Counter Pulsation, or ECP, federal prosecutors said.

The therapy involved a specialized bed equipped with pressure cuffs typically used to treat disabling angina — a chest pain or discomfort caused by the heart muscle not getting enough oxygen-rich blood, prosecutors said. The cuffs exert pressure upon patients’ lower extremities as a means to increase blood flow.

Shah bought 25 such beds and offered the treatment at more than 18 locations in Western Pennsylvania as well as in Ohio, New York and Florida.

Shah claimed that his ECP treatments could make patients “younger and smarter” and cure a range of ailments, including obesity, migraines, high and low blood pressure, diabetes and erectile dysfunction. He also claimed the process could boost energy and stamina and enhance weight loss.

The doctor promoted the treatment method in advertisements and waived deductibles and co-pays to encourage people to sign up for the therapy, prosecutors said.

Doctor’s offenses

Not only did Shah have patients undergo treatments that were “not medically necessary,” but he double-billed insurers and failed to supervise patients receiving the treatments, prosecutors said. In one case, a patient experienced an adverse effect during treatment and had to be taken by ambulance to a hospital.

“In certain instances, Shah never met patients for whom he billed for ECP treatments,” prosecutors said.

Shah required patients to undergo diagnostic ultrasounds as a precautionary measure, but he did not actually review the ultrasound images before approving new patients, prosecutors said.

Shah further fabricated patient files and made false statements about his practice, patients, compliance and record-keeping, prosecutors said. He instructed employees to indicate on billing forms that every patient had disabling angina even when they did not.

Over five years, Shah submitted fraudulent claims totaling more than $13 million and received more than $3.5 million in reimbursements.

FBI Pittsburgh Special Agent-in-Charge Robert Jones said, “Dr. Shah’s disregard for safe patient care goes against the medical ethics he was to uphold.”

Based on the conviction, Shah faces a maximum possible sentence of up to 10 years in prison and a fine up to $250,000, Brady said.

U.S. District Judge David S. Cercone scheduled a sentencing for Nov. 6.

Assistant U.S. Attorneys Eric G. Olshan and Nicole Vasquez Schmitt prosecuted the case with help from Assistant U.S. Attorney Philip O’Connor.

The FBI, Pennsylvania Attorney General’s Office and Medicaid Fraud Control Unit assisted in the investigation.

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