Providers convicted under the federal health care fraud statute can face severe penalties, but those penalties can be even more severe if the violation results in a patient’s death.
A mobile X-ray provider was recently sentenced to 10 years in prison when he was found guilty of multiple counts of health care fraud that resulted in death. When determining whether the X-ray provider’s violations resulted in death, the federal appellate court with jurisdiction for Maryland found that the patient’s death need only result from the fraud scheme as a whole, not a specific act of fraudulent billing related to the specific death.
Rafael Chikvashvili, a Baltimore resident, founded Alpha Diagnostics (Alpha), which provided portable, on-site diagnostic imaging services, such as X-rays, sonograms and electrocardiograms.
The case involved allegations that, for 20 years, Chikvashvili engaged in various fraudulent practices, such as requesting reimbursement for multiple X-rays when only one was taken and changing the attending physician’s diagnosis or symptom codes so the service would qualify for Medicare reimbursement.
Chikvashvili was also found to have directed technicians to interpret scans, prepare reports and submit the results to attending physicians under the guise that such interpretations and reports were done by board-certified radiologists and cardiologists.
Most pertinent to Chikvashvili’s conviction, on two occasions, patients died when it was determined that an Alpha employee failed to detect congestive heart failure.
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