Parsippany man pleads guilty to health care fraud

A Parsippany resident pleaded guilty Monday to health care fraud in a scheme to bill for diagnostic testing services he did not render and to enable a cardiologist to evade the Medicare program's pre-payment review of his claims.

Vijay Patel, 57, pleaded guilty before U.S. District Judge Esther Salas in Newark federal court to an information charging him with one count of health care fraud, according to a press release from U.S. Attorney Paul J. Fishman.

According to documents filed in this case and statements made in court:

From 2009 to the present, Patel has been the owner of a diagnostic testing facility in Parsippany called Mobile Diagnostic Testing. He was also a participant in Medicare.

Patel had an associate identified as "S.A.," who was a cardiologist and also a participant in the Medicare program.

From around 2009 through 2012, S.A.'s Medicare contractor had placed him on so-called "pre-payment review," which was initiated to ensure that S.A. was submitting claims within established rules and regulations and consistent with appropriate medical decision-making, and which required S.A. to submit medical and other documentation to support the services being billed to Medicare.

Under pre-payment review, claims for reimbursement that did not have the documentation necessary to support the services being billed are rejected by the Medicare contractor.

From November 2009 through October 2012, Patel and S.A. engaged in a scheme to defraud Medicare whereby S.A. paid Patel substantial sums of money to enable S.A. to evade Medicare's prepayment review. Patel admitted in court that he submitted claims to Medicare for diagnostic testing services that S.A. had performed as if Mobile Diagnostic had performed the services instead of S.A.

Once Medicare paid Patel and Mobile Diagnostic for diagnostic testing services that S.A. had actually provided, Patel then transferred a portion of the payment to S.A. and kept a substantial portion for himself.

The charge to which Patel pleaded guilty carries a maximum potential penalty of 10 years in prison and a maximum $250,000 fine, or twice the gain or loss caused by the offense. Sentencing is scheduled for March 23.