Insurance Fraud NEWS
California doc accused of phony heart treatments in $135M con
September 19, 2019, Huntington Beach, CA
A Huntington Beach doctor with a history of legal and disciplinary problems is one of seven healthcare professionals accused of participating in a Medicare fraud scheme that netted about $135 million through fraudulent insurance claims, according to federal prosecutors.
Nagesh Shetty, 74, was indicted Wednesday in connection with the scheme, which involved “medically unnecessary” cardiac treatments and testing through an Inglewood healthcare provider, Global Cardio Care, according to the U.S. attorney’s office.
Shetty said Thursday that he was unable to comment about the indictment because he hadn’t been notified of it.
Also charged are Dr. Ronald Weaver, 70, of Pacific Palisades; Sara Soulati, 49, of Santa Monica; Dr. John Weaver, 75, of Alhambra; Dr. Ronald Carlish, 78, of Pacific Palisades; Dr. Howard Elkin, 68, of Whittier and Dr. Wolfgang Scheele, 79, of Los Angeles.
Shetty was first licensed by the California Medical Board in 1979 and has operated practices in Costa Mesa, West Covina and the West Hills neighborhood of Los Angeles, according to documents and online records.
In 1994, Shetty was indicted in federal court on 28 counts of mail fraud on allegations of defrauding a Minnesota-based insurance company through “nonexistent, medically unnecessary or excessive medical treatment.” That case was later transferred to a California district court and charges were eventually dropped, court records show.
In 1996, Shetty was sentenced to 21 months in federal prison and fined $40,000 for filing false income tax returns and failing to report more than $400,000 in income over a three-year period in the 1980s, court documents show. At the time of the crimes, Shetty was owner and attending physician of Harbor Newport Medical Clinic in Costa Mesa.
While in prison, Shetty was indicted in 1998 on federal charges alleging that he defrauded military and private health insurance programs.
In 2000, a jury convicted Shetty of 26 felony counts of mail fraud and he was sentenced to two years in prison and three years’ supervised release, court records show. He also was ordered to pay restitution, including more than $28,000 to the U.S. Treasury and more than $19,000 to Blue Cross Blue Shield, court records show.
The California Medical Board revoked Shetty’s license in 2000, according to board records. His license to practice medicine also was revoked in New York in 1999 and Washington state in 2001, records show.
In 2005, Shetty petitioned the California board to reinstate his medical certificate. At the time, Shetty was bagging groceries and stocking shelves at a store and said his inability to practice his profession had caused emotional and financial strain for his wife and four children.
He was granted a probationary license, according to a decision by an administrative law judge, with the conditions that he complete an ethics course and a clinical training program, undergo monitoring and be barred from practicing solo, supervising physician assistants and handling any billing matters.
In 2009, Shetty completed his probation and the board reinstated his license.
In a disciplinary order effective April 26, the board issued Shetty a public reprimand stemming from a case in which he was accused of repeated negligence and failure to maintain adequate and accurate records involving a patient in 2016, according to California Department of Consumer Affairs records.
Source: The Los Angeles Times