NEW ORLEANS (WGNO) — The owner and operator of a Louisiana hospice facility has been convicted of Medicare fraud.
According to documents filed with the United States Attorney’s Office for the Eastern District of Louisiana, a jury found 67-year-old Shiva Akula guilty of overbilling and improperly billing patients through his business, Canon Healthcare, LLC.
The facility serviced patients throughout New Orleans, Baton Rouge, Covington and Gulfport, Mississippi.
A total of 23 counts of fraud were brought against Akula and according to court documents, the first eight stated he overcharged hospice patients for general inpatient services to “fraudulently maximize reimbursement from Medicare.”
His actions reportedly caused Medicare to pay $600 more per patient, per day rather than the appropriate level of care for multiple months per patient. Additionally, many of the patients charged were said to not hospice eligible, making the payments improper.
Documents state that between January 2013 and 2017, Akula billed 2,800 GIP monthly claims totaling $15.3 million.
Counts nine through 11 consisted of manipulating Medicare billing codes where Akula reportedly fraudulently billed for physician services and Medicare “unnecessarily.”
From 2013 to 2017, he submitted almost 1,053 claims resulting in Medicare paying approximately $223,601.
Counts 12 through 17, according to court documents, Akula fraudulently billed Medicare for history and physical forms, despite them being previously hand-copied by a family member and being unbillable in a hospice setting.
This resulted in 23,000 claims being made to Medicare for a payout of $2,281,251.
The final counts, 18 to 23, consisted of Akula fraudulently billing for home visits under a physician’s name despite the exams being performed by a nurse practitioner, patients not being hospice eligible, and the services not being included in daily hospice benefits offered by Canon.
Approximately 1,949 home visit claims were submitted to Medicare for a payout of $316,384.
During the five-day trial, 15 witness testimonies were heard and approximately 290 exhibits were seen.
Akula now faces the possibility of 10 years in prison, a max fine of $250,000, three years of supervised release and a $100 mandatory special assessment fee.
Sentencing is set at 2 p.m. on Feb. 21, 2024.
“Health care fraud schemes such as these profoundly impact our nation, not only because of the monetary loss triggered by the fraud but also by the damaging erosion of public trust. Our office, along with our investigative partners, will continue to work diligently to preserve taxpayer confidence in our medical institutions and seek justice for all victims of fraud,” said U.S. Attorney Duane A. Evans.
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