Home Healthcare Company Owner Sentenced to Nine Years in $2.8M Healthcare Fraud Case

The owner of a home healthcare company who was convicted last September for orchestrating a $2.8 million healthcare fraud and wire fraud conspiracy, and engaging in money laundering, aggravated identity theft, and witness tampering, has been sentenced to nine years in prison.

Indian national Yogesh K. Pancholi of Michigan owned and operated Shring Home Care Inc. He purchased the company using the identify of others because in 2017, he had entered into a voluntary settlement agreement which excluded him from billing Medicare and Medicaid.

False Claims and Kickbacks

According to an investigation into this healthcare fraud scheme by the U.S. Department of Health and Human Services, Pancholi caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home healthcare services that were referred in exchange for illegal payments or kickbacks paid by Pancholi.

In a two-month period, Pancholi and his co-conspirators submitted nearly $2.8 million in false and fraudulent claims to Medicare for home health services were not medically necessary, not eligible for Medicare reimbursement, or not provided at all.

Wire Fraud Using Shell Companies

According to court documents, that money was then funneled through bank accounts belonging to shell corporations and eventually into his accounts in India. After being indicted, but before his trial Pancholi — using the name of his former boss and making it look like it came from his former employer — wrote emails to various federal government agencies alleging a government witness, also from India, had engaged in “immigration/visa fraud” and that her visa should not be renewed.

Witness Tampering

“Based on its investigation, the government alleges that defendant sent the email in an attempt to hinder or prevent this witness from testifying against him,” the prosecution alleged in a court document. That is where the witness tampering charge came in.

Pancholi was arrested in September 2019 in a healthcare fraud law enforcement action in the Midwest that netted 52 others resulting in the loss of some $250 million. It was part of a coordinated effort involving the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners.

Study Provides Insight into Home Health Agency Fraud

A study published in the journal Social Science & Medicine last year offered interesting insights into the spread of fraudulent Medicare home healthcare billing in recent years.

Some common examples of fraudulent behavior in the home healthcare arena included agency owners billing for unnecessary or non-existent services, kickbacks to referral sources and sharing of patient IDs across networks of HHAs owned by organized criminal organizations.

There are an estimated 11,000 home health agencies in the U.S. providing care to Medicare beneficiaries. The study found a dramatic increase in home healthcare activity during a seven-year period (2002 to 2009) with costs more than doubling to $33.7 billion from $14.9 billion.

The authors found that the increase in expenditures was found in just a few hospital referral regions (HRRs) of the U.S. Lending support to their findings, these regions were usually where the DOJ created local anti-fraud offices, Miami being among them.

How We Can Help

The case should serve as a reminder of the efforts by law enforcement to fight healthcare fraud, uphold the integrity of healthcare systems and protect against financial exploitation.

Our firm represents healthcare professionals in state and federal court who are charged with fraudulent billing, kickbacks, Medicare and Medicaid fraud and false claims, among others. For more information, contact us at 305-358-4500 or email info@vitalehealthlaw.com.