Doctor Convicted for $5.4M Medicare Fraud Scheme

A federal jury convicted a New Jersey doctor today for causing the submission of over $5.4 million in fraudulent claims to Medicare for orthotic braces ordered through a telemarketing scheme.

According to court documents and evidence presented at trial, Adarsh Gupta, M.D., 51, of Sewell, signed thousands of prescriptions for orthotic braces for over 2,900 Medicare beneficiaries whom he was connected with by telemarketers who convinced the beneficiaries to accept unnecessary braces. After briefly speaking to the beneficiaries over the telephone, Gupta prescribed orthotic braces for them. For instance, Gupta prescribed a back brace, shoulder brace, wrist brace, and knee brace for an undercover agent after speaking with the agent for just over a minute on the telephone. In another instance, Gupta prescribed a knee brace for a Medicare beneficiary whose legs had previously been amputated. The evidence presented at trial showed that Gupta could not possibly have diagnosed the beneficiaries or determined that the braces were medically necessary during his brief telephonic encounters with them. Nonetheless, Gupta signed prescriptions for braces that falsely represented that the braces were medically necessary and that he diagnosed the beneficiaries, had a care plan for them, and recommended that they receive certain additional treatment. Gupta's false prescriptions were used by brace supply companies to bill Medicare more than $5.4 million.

The jury convicted Gupta of three counts of health care fraud and two counts of false statements relating to health care matters. He is scheduled to be sentenced on October 8, 2024 and faces a maximum penalty of 10 years in prison on each of the health care fraud counts and five years in prison on each of the false statements relating to health care matters counts. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department's Criminal Division; Assistant Director Michael D. Nordwall of the FBI's Criminal Investigative Division; and Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

The FBI and HHS-OIG investigated the case.

Trial Attorneys Darren C. Halverson and Sarah E. Edwards of the Criminal Division's Fraud Section are prosecuting the case, with assistance from Assistant U.S. Attorney Kelly M. Lyons for the District of New Jersey. Trial Attorney Steven Michaels of the Special Matters Unit of the Criminal Division's Fraud Section assisted with filter matters.

The Fraud Section leads the Criminal Division's efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.