Shailesh Kothari, a/k/a Shue Kothari, 45, of Atlanta, Ga., the chief executive officer for Primera Medical Group, was arraigned before U.S. Magistrate Judge Alan J. Baverman on federal charges of conspiracy to commit healthcare fraud and aggravated identity theft. Kothari was charged in an information filed on October 12.
The charges allege Kothari committed healthcare fraud by submitting more than 4,500 fraudulent claims for allergy treatments. Co-defendant, Timothy McMenamin, the chief operating officer for Primera Medical Group, was also charged for his alleged role in the scheme.
The information only contains charges and these defendants are presumed innocent of the charges and it will be the government’s burden to prove the defendants’ guilt beyond a reasonable doubt at trial, the Justice Department acknowledged in the press release.
According to the U.S. Attorney for the Northern District of Georgia Byung J. Pak, the defendants allegedly sought more than $8.5 million in insurance payments after submitting thousands of fraudulent claims.
Kothari is a doctor of chiropractic medicine who was licensed to practice in Georgia since January 2009, according to a Justice Department press release. U.S. Attorney Pak, the charges, and other information presented in court show Primera Medical Group, Inc., was a health clinic in Atlanta that focused its practice on preventative wellness, specifically corporate wellness, concierge care, and allergy testing.
Primera Medical Group hired market research companies across the U.S. to recruit patients to participate in allergy testing. Patients were told that there would be no out-of- pocket expenses and that their insurance would cover the costs, in addition to being paid $65 to $100 for participating in the test, prosecutors allege.
The charges contained in the court papers allege that a patient’s blood was purportedly drawn so that it could be sent to a laboratory for allergy and other testing, regardless of whether the patient had any allergy symptoms and without any determination of medical necessity for the testing,. Primera Medical Group allegedly then billed the patient’s private insurer for multiple procedures, including blood tests, allergy immunology injections, or other laboratory tests.
When billing private insurers, Primera Medical Group used the National Provider Identifier (NPI) numbers of multiple doctors, allegedly without their knowledge and without those doctors having performed the services, the press release said.
As of July 2016, prosecutors allege, Primera Medical Group billed insurers for hundreds of blood tests that were not completed. When an insurance company requested the medical records to support some of the billed services, Kothari allegedly asked McMenamin to create false laboratory reports to submit to the insurance company. McMenamin allegedly created the false laboratory reports, and those false reports were provided to the insurance company to support the fraudulent billing.
Additionally, when a patient requested the results of a laboratory test that was not completed, McMenamin allegedly created false laboratory results for those patients. On multiple occasions, Kothari and McMenamin allegedly sent false laboratory reports directly to patients, prosecutors say.