Owner of Alpha Diagnostics Indicted in $7.5 Million Health Care Fraud Scheme
BALTIMORE, MD—A federal grand jury has indicted the owner of Alpha Diagnostics, Rafael Chikvashvili, age 67, of Baltimore, Maryland, on health care fraud and other charges related to a scheme to defraud Medicare and Medicaid of more than $7.5 million. The indictment was returned on September 11, 2014, and unsealed today. Chikvashvili had an initial appearance today in U.S. District Court in Baltimore and was released under the supervision of U.S. Pretrial Services.
The indictment was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; and Special Agent in Charge Stephen E. Vogt of the Federal Bureau of Investigation.
According to the indictment, Chikvashvili formed Alpha Diagnostics Services, Inc., which later became Alpha Diagnostics, LLC, in 1993, and always acted as Managing Member, Authorized Official, Managing Employee, President and Chief Executive Officer for Alpha Diagnostics. Chikvashvili holds a PhD in mathematics, but was never a medical doctor or licensed physician. Alpha Diagnostics was principally a mobile diagnostic medical service provider of X-rays, but also procured and transmitted mobile diagnostic ultrasound tests, electrocardiograms (“EKGs”), echocardiograms, and other medical tests. Alpha Diagnostics operated in Maryland, Delaware, Pennsylvania, Virginia and the District of Columbia.
The 12-count indictment alleges that beginning at least in 1997 through October 2013, Chikvashvili defrauded Medicare and Medicaid by creating false radiology, ultrasound and cardiologic interpretation reports; by submitting insurance claims for medical examination interpretations that were never completed by licensed physicians; by falsely representing to Medicare and Medicaid, as well as to treating physicians, that the interpretations had in fact been completed by actual licensed physicians; and by submitting insurance claims for radiology, ultrasound and cardiologic examinations (and their associated costs) that were never performed, and/or which were in excess of the number of examinations ordered by the treating physician.
Specifically, the indictment alleges that Chikvashvili instructed his non-physician employees to: perform interpretations of X-rays, medical tests, ultrasounds and cardiologic exams in lieu of licensed radiologists and physicians; draft a licensed “physician’s” examination report in the name of a licensed physician to which Chikvashvili caused a copy of the handwritten signature of the actual physician to be affixed to the report. The indictment alleges that the names and titles of physicians Chikvashili used were physicians who did not interpret the examinations, nor provide the medical findings to create the reports. If a patient caregiver contacted Alpha Diagnostics to question medical interpretations, Chikvashvili allegedly reassigned the test/examination to a licensed physician for a second interpretation without informing the licensed physician of the prior interpretation. In addition, Chikvashvili instructed a non-physician employee to represent that he was a physician while speaking with others on the phone.
According to the indictment, Chikvashvili and Alpha Diagnostics routinely submitted insurance claims to Medicare and Medicaid that, among other things, exaggerated the services performed by its technologists or exceeded the services ordered by the treating physician; overcharged for transportation costs; and falsely represented that Alpha Diagnostics was properly overseen by supervising physicians.
Finally, the indictment seeks forfeiture of at least $7.5 million, including two properties, luxury vehicles, bank and investment accounts, and a safe deposit box.
Chikvashvili faces a maximum sentence of 10 years in prison for health care fraud; a maximum of five years in prison for each of nine counts of making false statements; and a mandatory two years, consecutive to any other sentence imposed, for two counts of aggravated identity theft.
An indictment is not a finding of guilt. An individual charged by indictment is presumed innocent unless and until proven guilty at some later criminal proceedings.
United States Attorney Rod J. Rosenstein praised the HHS-OIG and the FBI for their work in the investigation. Mr. Rosenstein thanked Assistant United States Attorney Mark W. Crooks, who is prosecuting the case.