Brookline Doctor Pleads Guilty for Running Medicaid Kickback and False Billing Scheme

Brookline Doctor Pleads Guilty for Running Medicaid Kickback and False Billing Scheme

Boston – On April 6, 2015 in Suffolk Superior Court Dr. Punyamurtula Kishore pleaded guilty to running

an intricate Medicaid fraud scheme involving millions of dollars in taxpayer funds. Kishore’s

company Preventive Medicine Associates (PMA) pleaded guilty to eight counts of Medicaid kickbacks,

19 counts of Medicaid false claims and eleven counts of larceny. Kishore pleaded guilty to one

count of larceny. He was sentenced to 360 days in the House of Correction, with 11 months to serve

and the balance suspended for 10 years. As a condition to his sentence, Kishore agreed to surrender

his medical license. Kishore and PMA were ordered to pay, jointly and severally, a total of $9.3 million

in restitution.

Kishore previously owned and managed PMA, a network of 29 medical branches throughout Massachusetts,

including physician office laboratories and one independent clinical laboratory. Based on

the investigation, Kishore used bribes, or kickbacks, to induce sober house owners to send their residents’

urine drug screening business to his laboratories for testing. Residents were typically screened

three times per week. A urine drug screen may be billed to MassHealth by a physician if the screen is

medically necessary. Drug screens generally are billed to the MassHealth program for approximately

$100 to $200. Kishore manipulated his business relationships with sober house owners to illegally obtain

tens of thousands of drug screens paid for by MassHealth for sober house residents who were

never treated by PMA providers. Kishore and PMA billed MassHealth for millions of dollars in drug

screens using the names of PMA physicians and nurse practitioners who were not actually treating

the patients or determining the drug screens to be medically necessary. State regulations require that

the services must be medically necessary and the provider must be physically present and actively

involved in the treatment of the member. The case was prosecuted by Assistant Attorneys General

Angela Neal, David Scheffler and Lee Hettinger of Attorney General Healey’s Medicaid Fraud Division.

The case was investigated by the Attorney General’s Office, Massachusetts State Police, U.S. Department

of Health and Human Services Office of the Inspector General with assistance from the IFB.