Ex-Beach doctors suspected of filing fraudulent claims

VIRGINIA BEACH

The Defense Department is investigating a husband-and-wife doctor team in a suspected scam of the Tricare insurance program, according to a federal search warrant.

A defense investigator says in the warrant that the couple bilked nearly $200,000 from the government health insurance program by billing for anesthesia services that were never delivered.

Drs. Kandarp Shah and Kalyani Shah, both gastroenterologists, are suspected of filing the fraudulent claims between 2003 and 2008 while operating the Medical Diagnostic and Treatment Center at 700 Independence Circle, Virginia Beach, the warrant says. The business has since closed, and the couple now live in Fresno, Calif.

In that period, Tricare paid the couple a little more than $1.1 million on 9,229 claims for services.

An audit of the couple's medical records determined that they billed Tricare for anesthesia services but actually performed conscious sedation in their medical procedures, according to the warrant. Gastroenterologists perform internal diagnostics, such as colonoscopies. The couple received $195,000 for anesthesia services from Tricare, money they weren't entitled to, the warrant says.

There was no indication in the court records that any patients were harmed.

Neither of the Shahs has credentials in anesthesiology nor did they employ an anesthesiologist at their practice, the warrant says.

A special agent with the Defense Criminal Investigative Service, the investigatory arm of the Defense Department, filed for the search warrant of a self-storage unit rented by the Shahs in Virginia Beach.

The agent, Theodore Welch, and other health care fraud specialists were searching for the Shahs' medical records and computers but did not seize anything from the storage unit. Welch did not return a call seeking comment.

No charges have been filed, and the U.S. Attorney's Office declined to comment on the investigation.

Welch wrote in the warrant that he believes the Shahs "committed and caused to be committed" health care fraud, a federal crime punishable by up to 10 years in prison.

The warrant, filed in U.S. District Court, says Kandarp Shah has been employed at the Central California Faculty Medical Group and that his wife is not working. A receptionist at that office said Shah no longer works there. Messages left at Shah's private office were not returned.

The Virginia Board of Medicine lists both of their medical licenses as inactive.

Tricare is the government's health plan for active duty, reserve and retired service members and their dependents. The $40 billion program covers about 9.2 million patients.

Tim McGlone, (757) 446-2343, tim.mcglone@pilotonline.com