Orange Man Pleads Guilty to Health Care Fraud Charges Related to Overbilling Medicaid and Medicare by $2.5 Million

A man who lives in Orange, Ohio admitted to overbilling Medicaid and Medicare by more than $2.5 million, said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio.

Divyesh “David” C. Patel, age 39, pleaded guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel is expected to be sentenced later this year.

“This defendant enriched himself and his company by flouting rules designed to protect the public,” Dettelbach said.

“Mr. Patel defrauded the tax payers by scamming Medicaid and Medicare,” said Stephen D. Anthony, Special Agent in Charge of the FBI’s Cleveland Field Office. “Waste, fraud, and abuse take critical resources out of our health care system and contribute to the rising cost of health care for all Americans.”

Patel was the owner and president of Alpine Nursing Care Inc., located at 4753 Northfield Road, Suite 5, North Randall, Ohio, and employed Belita Mable Bush as the office manager and director of provider services from June 1, 2006 through October 18, 2009, according to court documents.

Patel and Alpine employed Bush to prepare and submit the billings to Medicaid and Medicare for reimbursement for services provided by Alpine as a home health care provider, even though Patel knew that Bush had been previously convicted of a health care-related felony that excluded Bush from being involved in any way with Alpine’s Medicaid and Medicare billings, according to court documents.

In addition to the fact that Bush was excluded from handling Alpine’s medical billings, Patel was aware that Bush falsified documents related to health care services allegedly provided to home health patients where the services were never provided or were provided by home health aide that had previous criminal convictions that excluded them from providing health services in people’s houses, according to court documents.

As a result of the conspiracy, Medicaid and Medicare suffered a loss of approximately $2,564,392, according to court documents.

Bush was convicted on related charges and is scheduled to be sentenced May 28.

The defendants’ sentence will be determined by the court after review of factors unique to this case, including any prior criminal record, the defendants’ role in the offense, and the characteristics of the violation. In all cases, the sentence will not exceed the statutory maximum and, in most cases, it will be less than the maximum.

This case is being prosecuted by Assistant U.S. Attorney Mark S. Bennett and Special Assistant General Constance A. Nearhood, following an investigation by the Office of the Inspector General, Department of Health and Human Services, Cleveland, Ohio; Ohio Attorney General’s Office, Medicaid Fraud Control Unit; and the Federal Bureau of Investigation, Cleveland, Ohio.

An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.

If you suspect health care fraud, waste, or abuse, please report it by calling HHS Office of Inspector General at 800-447-8477, the Centers for Medicare and Medicaid Services at 800-633-4227, or the FBI Cleveland Field Office at (216) 522-1400. To learn more about health care fraud prevention and enforcement, go to www.stopmedicarefraud.gov.