U.S. Attorney's Office
Southern District of New York
(212) 637-2600
October 16, 2014

Yonkers Cardiologist Convicted of Fraud Sentenced in White Plains Federal Court to Three Years in Prison

Preet Bharara, the United States Attorney for the Southern District of New York, announced that ROHAN WIJETILAKA was sentenced today by U.S. District Judge Vincent L. Briccetti in White Plains federal court to three years in prison for health care fraud. WIJETILAKA, who previously pled guilty in June 2014, was also ordered by Judge Briccetti to pay a total of $2 million in forfeiture and restitution.

U.S. Attorney Preet Bharara stated: “Sworn to use his education and skills to comfort and heal, Wijetilaka instead resorted to fraud on a massive scale, abusing the trust placed in him by his patients and by the community. Our Office commends the investigative efforts in this case of the Drug Enforcement Administration, the Federal Bureau of Investigation, the U.S. Department of Health and Human Services – Office of the Inspector General, the Westchester County Department of Public Safety, and the Yonkers Police Department.”

According to the Indictment to which WIJETILAKA pled guilty, statements made during the plea, and other information presented during the case:

WIJETILAKA, 65, of Manhattan, was a cardiologist licensed to practice medicine in the State of New York. He maintained a cardiology practice in Westchester County, New York (the “Wijetilaka Practice”), which included examination rooms and diagnostic testing facilities. WIJETILAKA obtained payments for diagnostic tests, office visits, and other procedures (collectively, the “Medical Procedures”) from Medicare and numerous private health insurance providers (the “Health Insurance Providers”).

In July 2007, WIJETILAKA received written notice from the New York State Department of Health, State Board for Professional Medical Conduct (the “State Board”), that he was the subject of a State Board investigation. In November 2011, following an initial inquiry, the State Board served WIJETILAKA with formal charges of professional misconduct relating, in part, to alleged fraudulent billing. In June 2012, after multiple hearings, a State Board committee found against WIJETILAKA on 41 specifications of professional misconduct, including fraudulent billing, filing false reports, and failing to maintain adequate medical records.

To receive payments for Medical Procedures from the Health Insurance Providers, WIJETILAKA was required, among other things, to submit, and cause the Wijetilaka Practice to submit, information to the Health Insurance Providers regarding aspects of the Medical Procedures he performed or caused to be performed. For instance, in order to bill Medicare for a particular patient procedure, WIJETILAKA had to submit a form that stated a diagnosis of the patient’s condition and provided a procedure code identifying the service or services rendered. WIJETILAKA also had to certify, in substance, that the services rendered were medically necessary and furnished by the Wijetilaka Practice.

Between 2009 and 2011, WIJETILAKA routinely performed Medical Procedures at the Wijetilaka Practice for which WIJETILAKA and the Wijetilaka Practice submitted claims to Health Insurance Providers. During this period, WIJETILAKA submitted millions of dollars of claims to Medicare alone.

With respect to many of the Medical Procedures he performed or caused to be performed, WIJETILAKA furnished, and caused to be furnished, false information to Health Insurance Providers (the “Fraudulent Claims”) that resulted in the Health Insurance Providers paying the Wijetilaka Practice for procedures that were medically unnecessary and served no meaningful diagnostic purpose. Among other things, WIJETILAKA falsely billed for office visits that did not occur and falsely reported non-existent symptoms to justify costly and unnecessary diagnostic tests.

In order to attract additional patients to the Wijetilaka Practice and maintain existing patients, WIJETILAKA would and did provide Schedule II controlled substances, including oxycodone, to drug-seeking patients, in exchange for those patients undergoing unnecessary diagnostic tests and other Medical Procedures.

In this manner, WIJETILAKA defrauded Health Insurance Providers out of money paid to the Wijetilaka Practice as a result of the Fraudulent Claims.

Despite being on notice that he was under State Board investigation in July 2007, and being formally charged with professional misconduct by the State Board in or about November 2011, for, among other things, fraudulent billing, WIJETILAKA continued his illicit scheme. To conceal his scheme from the State Board, WIJETILAKA generated additional false records to justify tests that he had performed.

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Mr. Bharara praised the investigative efforts of the Drug Enforcement Administration, the Federal Bureau of Investigation, the U.S. Department of Health and Human Services – Office of the Inspector General, the Westchester County Department of Public Safety, and the Yonkers Police Department.

The case is being handled by the Office’s White Plains Division. Assistant U.S. Attorneys Ilan Graff, Andrew Bauer, Kathryn Martin, and Benjamin Allee are in charge of the prosecution.

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