Two Virginia doctors allegedly filed 9,229 fraudulent insurance claims

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A husband-and-wife doctor team, formerly of Virginia Beach, Va., are the focus of a U.S. Defense Department investigation into suspected fraud of the TRICARE government health insurance program.

Drs. Kandarp Shah and Kalyani Shah, both gastroenterologists, are suspected of filing $200,000 in fraudulent claims with the program by billing for anesthesia services that were never delivered, according to a federal search warrant obtained by The Virginian-Pilot.

The Shahs filed the insurance claims between 2003 and 2008, while operating the Medical Diagnostic and Treatment Center in Virginia Beach, according to the warrant. That business has closed and the couple now resides in Fresno, Calif.

During that period, Tricare paid the couple a little more than $1.1 million to resolve 9,229 claims for services, according to the report.

An audit of their medical records indicate that they billed the program for anesthesia services, but actually performed conscious sedation in their medical procedures, the report said. The warrant states that neither doctor has credentials in anesthesiology nor did they employ an anesthesiologist at their Virginia Beach practice, according to the report.

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

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