A resident of Fox Chapel, Pennsylvania, Samirkumar J. Shah, 58, was sentenced to 78 months of imprisonment followed by three years of supervised release. The evidence introduced at trial established that between 2008 and 2013, Shah, a practicing cardiologist, submitted fraudulent claims to private insurance plans—Highmark Blue Cross Blue Shield (Highmark), UPMC Health Plan (UPMC)—as well as government insurance programs—Medicare and Medicaid (through Gateway Health Plan)—for an outpatient treatment known as external counterpulsation, or ECP. ECP involves the use of a specialized bed equipped with pressure cuffs, which exert pressure to patients’ lower extremities as a means to increase blood flow to the heart. The evidence at trial further demonstrated that insurers only reimbursed for ECP treatments of patients who suffered from disabling angina—or significant chest pain caused by decreased blood flow to the heart—and only when a physician supervised the treatment.
The evidence also showed that patients were required to undergo certain diagnostic ultrasounds as a precautionary measure prior to starting ECP—in part to rule out blood clots that could cause a stroke or heart attack during the treatment. Nevertheless, witness testimony established that Shah did not review any of the ultrasound imagery before approving new patients to begin ECP, placing his patients at risk of serious injury or even death.
