A Waxahachie, Texas, nurse practitioner has been sentenced to 20 years in federal prison and ordered to repay more than $52 million in restitution for his role in a healthcare and insurance fraud scheme, according to Acting U.S. Attorney for the Northern District of Texas Prerak Shah.
Trivikram Reddy, 39, pleaded guilty to conspiracy to commit wire fraud in October 2020. He had been accused of engaging in a scheme to defrauded Medicare and private insurance providers.
According to court documents, Reddy, a licensed nurse practitioner, devised a scheme to defraud Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana and Cigna.
According to the U.S. Attorney’ Office, Reddy and co-conspirators created false patient bills using the provider numbers of six doctors as the treating physicians on the claims. All the claims were false and at no time did the six doctors provide billable services to any of Reddy’s medical clinics.
On June 3, 2019, federal agents served a civil investigative demand at one of Reddy’s medical clinics. When law enforcement arrived at the site, agents found Reddy’s staff manufacturing medical records. Following the encounter, on June 8, Reddy closed the clinic and terminated his business entity with the Texas Secretary of State, the justice department said.
On June 13, 2019, Reddy made the first of multiple wire transfers which, in sum, totaled more than $55 million. A forensic financial analysis directly tied the money to fraudulent health care claims submitted by Reddy.
Federal agents requested medical records to justify millions of dollars of paid Medicare claims paid between January 2014 and June 2019. Reddy and his staff spent the next four months manufacturing fake medical records to turn over to authorities.
This case was investigated by the FBI Dallas Field office and Health and Human Services-Office of the Inspector General (HHS-OIG). Assistant U.S. Attorney Donna Strittmatter Max and Special Assistant U.S. Attorney Matt Smid prosecuted the case.
Source: U.S. Attorney’s Office for the Northern District of Texas
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