The chief executive officer and the chief operating officer of a defunct Atlanta medical group were sentenced to prison Thursday after being convicted of conspiracy to commit healthcare fraud and aggravated identity theft.
Shailesh Kothari, who also goes by Shue Kothari, was the CEO of Atlanta-based Primera Medical Group, Inc., and he was sentenced alongside his former COO Timothy McMenamin, U.S. Attorney Byung J. “BJay” Pak said in a news release.
The duo was found guilty of participating in an allergy testing scheme, where they sought more than $8.5 million in insurance payments for more than 4,500 fraudulent claims, the release said.
Kothari, who owned the company and was a licensed doctor of chiropractic medicine, hired market research companies to recruit patients to participate in allergy testing, the release said. The patients were paid to participate, despite some not having any symptoms that would require necessary testing.
Primera would bill the patients’ private insurers for the blood tests, using National Provider Identifier numbers of multiple doctors without their knowledge and without those doctors having performed the services that were billed, the release said. Those doctors also didn’t order the laboratory tests or the allergy immunotherapy injections, which were billed for nearly every patient.
As of July 2016, Primera was billing for hundreds of blood tests that had not been completed, so McMenamin created false laboratory results to submit to insurance companies, the release said.
Because the laboratory tests weren’t completed for many patients, he also created false laboratory results to send them directly, the release said. In one instance, Primera sent fabricated lab results to the family of a 5-year-old girl who was suffering from an unknown reaction.
Kothari and McMenamin were arrested by the FBI after agents raided a Primera office on Peachtree Street in Buckhead in March 2018. Kothari, 45, pleaded guilty in October, and McMenamin, 32, pleaded guilty the next month.
Kothari was sentenced to six years and nine months in prison, and McMenamin was sentenced to seven years and 10 months. Both will also have three years of supervised release after their time in prison, and both were ordered to pay just over $1.5 million in restitution.
Blue Cross Blue Shield of Georgia’s special investigations unit assisted in the investigation.
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