Last week I attended the American Bar Association's National Institute on Health Care Fraud. As is often the case at these health care fraud conferences, the most fascinating sessions are the ones where the key players in an actual fraud case recount the investigation details, giving the audience a play-by-play account of the entire investigation process, from the detection of a fraud through to the conviction. And while the process is interesting enough, it's the perpetrators of these frauds who really are the most fascinating.

This year's case was U.S. v Patel, a cardiology health care fraud case that resulted in a jury conviction on 51 counts of fraud, described by one presenting investigator as something out of a John Grisham novel. Aside from the revealing look into the actions of a callous and greedy doctor, the case also brought up some interesting theoretical questions, such as whether a physician's own notes can be used as evidence against him and how a massive fraud can garner monetary sanctions of just of fraction of the proceeds.

The Whistleblower

It all started in February 2002, when a nurse working with Dr. Mehmood Patel, a cardiologist in Lafayette, Louisiana, contacted the U.S. Department of Health and Human Services (HHS) with his concerns that Dr. Patel was performing unnecessary medical procedures and committing fraudulent billing.

The nurse met with HHS Agent Barbara Alleman, one of the presenters at the conference, and presented documents supporting his claims. After the meeting he continued to gather records from the mobile lab to back up his complaint. At the end of March, he mailed Alleman additional information, including lists of Dr. Patel's patients who had undergone angiograms.

Dr. Patel was indicted by a grand jury on 91 counts of health care fraud. The indictment alleged that over a three-year period Dr. Patel defrauded Medicare, Medicaid, and private insurers by billing for medically unnecessary procedures. The 91 counts were for medical procedures that were conducted on 74 different patients, some of whom would later be called upon to testify against the doctor.

The presentation of the investigation and outcome by HHS agent Alleman, prosecuting attorney Kelly Uebinger and healthcare attorney Richard Westling provided some behind-the-scenes detail that made the case even more interesting. For example, during the trial Dr. Patel insisted he was not in it for the money, but for the care of his patients. The prosecution produced a stack of checks the doctor had written to himself for between several hundred thousand and a million dollars each.

The Trial

It took six years for the case to go to trial, and when it did, in September of 2008, it spanned three and a half months and experienced delays due to a hurricane and the removal and assignment of a new jury foreperson. The list of witnesses was in the hundreds. The government had at least one expert testify about each of the 91 procedures Dr. Patel was accused of performing unnecessarily.

Testimony at the trial revealed that Dr. Patel had been falsifying patient symptoms in medical records, falsifying findings on medical tests, and performing unnecessary coronary procedures, including deploying angioplasty balloons and stents. He deployed stents, balloons and radiation in coronary arteries that had little or insignificant disease, at great risk to his patients.

The presenters showed testimony from some of the patients who had received treatment from Dr. Patel, demonstrating the price some of his victims paid in loss of health and quality of life. In fact, some patients under Dr. Patel's care died, but the prosecution team was unable to draw a direct link from the procedures to their deaths.

The Verdict

After six days of deliberation, the jury convicted Dr. Patel on 51 counts of health care fraud and acquitted him on the other 40 counts. The district court sentenced him to the statutory maximum prison sentence of 120 months on each count, to run concurrently and ordered him to pay:

• the maximum fine of $175,000
• the costs of incarceration and supervision
• $387,511.56 in restitution
• $48,631.39 forfeiture

The court estimated his net worth as $6.4 million. You do the math.