Nurse Practitioner Sentenced to 20 Years, Ordered to Pay More Than $52 Million in Restitution

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MidlevelWTF

May 28, 2021 • 3 min read

From the U.S. Attorney's Office in the Northern District of Texas:

A Waxahachie nurse practitioner was sentenced yesterday to 20 years in federal prison and ordered to repay more than $52 million in restitution for his role in a health care fraud conspiracy, announced Acting U.S. Attorney for the Northern District of Texas Prerak Shah.

Trivikram Reddy, 39, pleaded guilty to conspiracy to commit wire fraud in October 2020. He was sentenced on Tuesday by U.S. District Judge Ada Brown.

“Mr. Reddy engaged in a scheme that defrauded Medicare and private insurance providers out of millions of dollars,” said Acting U.S. Attorney Shah. “The Justice Department will continue to aggressively prosecute all types of health care fraud to protect the integrity of our health care system and ensure that criminals are held accountable.”

“Health care fraud affects everyone, it causes billions of dollars in losses each year and erodes trust in our health care system,” said Dallas FBI Special Agent in Charge Matthew DeSarno. “Mr. Reddy’s scheme defrauded multiple companies and put the professional reputation of six doctors in jeopardy all to line his own pockets. Along with our law enforcement partners, the FBI will continue to root out fraud in the health care industry and protect the public from illegal schemes.”

“When nurse practitioner Trivikram Reddy stole the identities of physicians to defraud Medicare and other insurers to enrich himself, he violated the basic trust that the public extends to healthcare professionals,” said Special Agent in Charge Miranda L. Bennett of the HHS-OIG Dallas Regional Office. “Today’s sentence sends a message to corrupt medical professionals that law enforcement will do everything possible to root out all forms of waste, fraud and abuse in our federal health care programs.”

According to court documents, Mr. Reddy, a licensed nurse practitioner, devised a scheme to defraud Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana, and Cigna.

Mr. Reddy and co-conspirators created false patient bills using the provider numbers of six doctors as the treating physicians on the claims. All the claims were false and at no time did the six doctors provide billable services to any of Mr. Reddy’s medical clinics.

On June 3, 2019, federal agents served a civil investigative demand at one of Mr. Reddy’s medical clinics. When law enforcement arrived at the site, agents found Mr. Reddy’s staff manufacturing medical records. Following the encounter, on June 8, Mr. Reddy closed the clinic and terminated his business entity with the Texas Secretary of State.

On June 13, 2019, Mr. Reddy made the first of multiple wire transfers which, in sum, totaled more than $55 million. A forensic financial analysis directly tied the money to fraudulent health care claims submitted by Mr. Reddy.

Federal agents requested medical records to justify millions of dollars of paid Medicare claims paid between January 2014 and June 2019. Mr. Reddy and his staff spent the next four months manufacturing fake medical records to turn over to authorities.

This case was investigated by the FBI Dallas Field office and Health and Human Services-Office of the Inspector General (HHS-OIG). Assistant U.S. Attorney Donna Strittmatter Max and Special Assistant U.S. Attorney Matt Smid prosecuted the case.