Saturday, 20 February 2016 23:05

U.S. v. Rafael Chikvashvili: Health Care Fraud, Aggravated Identity Theft

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Rafael Chikvashvili, 67, was convicted in federal court in Maryland on charges of health care fraud resulting in death, wire fraud conspiracy, false statements and aggravated identity theft in regard to a scheme to defraud Medicaid and Medicare of over $7.5 million. Chikvashvili was the owner of Alpha Diagnostics, a portable diagnostic services provider. He was the CEO, managing member, managing employee, and president of the firm, and while he has a PhD in mathematics, he was never a licensed physician or medical doctor.

The company's clients included nursing homes with patients covered by Medicare and Medicaid and operated in several states, including Maryland, Delaware, Pennsylvania, Virginia and the District of Columbia. It was headquartered in Maryland.

The jury in the case found that Chikvashvili conspired with others to defraud the federal programs from 1997 through October of 2013 through the creation of false radiology, ultrasound and cardiologic interpretation reports, and by submitting insurance claims for medical exams that were never performed by licensed physicians and by submitting claims for transportation and other charges that the firm was not entitled to collect.

According to U.S. Attorney Rod J. Rosenstein, evidence showed that patients did not receive the medical services they needed and were billed for services that were not provided. Two patients died as a result of x-rays that were not reviewed by qualified radiologists.

Witnesses testified that non-physician employees were instructed by Chikvashvili to interpret x-rays, ultrasounds, and cardiologic exams. In 2012, Timothy Emeigh, Vice President in Charge of Operations at the company, was on vacation in Jamaica and received direction from Chikvashvili to view medical images via his personal laptop and to create false physician interpretation reports that were subsequently submitted in false claims to Medicare.

Additionally, Chikvashvili also instructed employees to create licensed physician examination reports and caused a copy of the handwritten signature of the actual doctor to be placed on the report; he sometimes forged the doctor's signature himself to create the appearance that a licensed physician had interpreted the report.

Chikvashvili is facing a maximum prison sentence of life for each of the two counts of health care fraud resulting in death, 10 years for each of the nine counts of health care fraud, 20 years for each of the eight counts of wire fraud and the conspiracy count, five years for each of the 11 counts of false statements regarding health care issues, and a mandatory two-year sentence for two counts of aggravated identity theft, which would be served consecutive to any other sentence imposed by the court.

Resources

U.S. v. Rafael Chikvashvili, Department of Justice. U.S. Attorney’s Office District of Maryland

 

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