Corporate Compliance

Two Chicago physicians accused of Medicare fraud

Compliance Monitor, February 4, 2009

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Federal authorities have charged four Chicago-area individuals, including two physicians, in three unrelated healthcare fraud cases, according to a Department of Justice (DOJ) press release.
 
Sushil Sheth, MD, a cardiologist with privileges at three unnamed Chicago-area hospitals, allegedly submitted claims for expensive cardiac procedures that never occurred. Sheth allegedly exploited his hospital privileges to use patients’ information without their knowledge or consent. The scheme allegedly netted Sheth approximately $13.4 million between January 2002 and July 2007—$8.3 million from Medicare and $5.1 million from other healthcare insurers.
 
Otto Garcia Montenegro, MD, a general practice physician, allegedly submitted false health insurance claims totaling approximately $500,000 to private medical insurance providers. The insurers paid Montenegro approximately $373,000 based on the false claims, the charges allege.
 
Stephen Anthony Pam, owner of two Chicago-area durable medical equipment (DME) companies, and Shavon Keyona Williams, a former employee of both companies, were each indicted on 34 counts of healthcare fraud for allegedly billing Medicare and Medicaid for power wheelchairs or orthotic devices were not medically necessary for beneficiaries.



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