Jury Convicts Hospice Owner for Defrauding Medicare

NEW ORLEANS – U.S. Attorney Duane A. Evans announced that on November 6, 2023, a federal jury  convicted SHIVA AKULA, age 67, of New Orleans, of health care fraud related to fraudulent claims billed to Medicare.  AKULA owned and oversaw the day-to-day operations of Canon Healthcare, LLC, a hospice facility with offices in the New Orleans area, Baton Rouge, Covington, and Gulfport, Mississippi.  Between January 2013 and December 2019, Canon’s New Orleans area office billed Medicare approximately $62 million and was paid approximately $47 million.

The jury convicted AKULA on all 23 counts of health care fraud charged in the indictment. Counts 1 through 8 involved AKULA’s overbilling for hospice patients for General Inpatient (“GIP”) services to fraudulently maximize reimbursement from Medicare.  By improperly billing for GIP, AKULA fraudulently caused Medicare to pay approximately $600 more per patient, per day, than it would have for the appropriate level of care, for multiple months per patient. Moreover, many of the patients whose claims were fraudulently billed to Medicare were not hospice eligible, meaning any Medicare hospice payments for these patients were improper. Between January 2013 and August 2017, AKULA billed over 2,800 monthly claims for GIP billing, totaling approximately $15.3 million.

Additionally, the jury convicted AKULA for multiple counts related to manipulating Medicare billing codes, known as Common Procedural Terminology (“CPT”) codes.  Counts 9 through 11 involved AKULA’s fraudulent billing for physician services under CPT code 99236.  AKULA fraudulently billed Medicare for these services, despite such services being medically unnecessary, and despite their  inclusion in the daily hospice benefit Canon already received for its patients.  Between January 2013 and August 2017, AKULA submitted approximately 1,053 claims for CPT code 99236 and was paid approximately $223,601 by Medicare.

Counts 12 through 17 involved AKULA’s fraudulent billing of History and Physical forms under CPT code 99233.  AKULA fraudulently billed Medicare for these forms, despite their being hand-copied by a member of AKULA’s family based on work performed by referring physicians not employed by Canon, and despite their being unbillable in the hospice setting. Between January 2013 and August 2017, AKULA submitted approximately 23,000 claims to Medicare for CPT code 99233 and was paid approximately $2,281,251.

Finally, Counts 18 through 23 involved AKULA’s fraudulent billing for home visits under CPT code 99350.  AKULA fraudulently billed Medicare for visits under a physician’s name, even though they were performed by a nurse practitioner, the patients were not hospice eligible, and the services were included in the daily hospice benefit Canon already received for its patients. Between January 2013 and August 2017, AKULA submitted claims to Medicare for approximately 1,949 home visits using CPT code 99350 and was paid approximately $316,384.

U.S. District Judge Lance M. Africk presided over the five-day trial during which the government called fifteen witnesses and presented approximately 290 exhibits.

As to each of the 23 counts of health care fraud, AKULA may receive a maximum sentence of ten years in prison, a maximum fine of up to $250,000, up to three years of supervised release, and a $100 mandatory special assessment fee.  Judge Africk scheduled sentencing in this case for February 21, 2024, at 2:00 p.m.

“Health care fraud schemes such as these profoundly impact our nation, not only because of the monetary loss triggered by the fraud, but also by the damaging erosion of public trust”, said U.S. Attorney Duane A. Evans.  “Our office, along with our investigative partners, will continue to work diligently to preserve taxpayer confidence in our medical institutions and seek justice for all victims of fraud.”

“Mr. Akula took advantage of the American taxpayer by billing for services that weren’t medically necessary, and in some cases, didn’t happen at all,” said Douglas A. Williams, Jr., Special Agent in Charge for FBI New Orleans.  “The FBI will continue its work to uncover fraudulent schemes like this that take advantage of people when they are most vulnerable.”

“A federal jury correctly found Shiva Akula, MD guilty on all 23 counts of health care fraud,” said Jason E. Meadows, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG).  “Medical providers who are motivated by greed place our most vulnerable citizens at risk, and HHS-OIG remains committed to working with our law enforcement partners to identify and investigate greedy providers who defraud our federal health care programs.”

This case was investigated by the Federal Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, and the Louisiana Department of Justice, Medicaid Fraud Control Unit. Assistant U.S. Attorneys Kathryn McHugh and J. Ryan McLaren, an attorney in the Appellate Unit, are in charge of the prosecution.