Shiva Akula, the owner and operator of Canon Healthcare, LLC, was convicted by a Louisiana jury of 23 counts of health care fraud. The jury found that Akula defrauded Medicare by overbilling and manipulating various Common Procedural Terminology (“CPT”) codes.

According to evidence presented at trial, Akula billed Medicare for approximately $62 million and received approximately $47 million in payments between January 2013 and December 2019. Akula overbilled for General Inpatient services (“GIP”) which caused Medicare to pay $600 more per patient and per day, from January 2013 to August 2017. As a result, Medicare paid over $15 million for over 2,800 monthly claims for GIP. The jury was also presented evidence that showed many of the patients were not hospice eligible such that any hospice payment by Medicare was improper.

In addition to overbilling, the jury was presented with evidence that Akula fraudulently billed for physician services, fraudulent history and physical forms, and for home visits. Between January 2013 and August 2017, Medicare paid Akula close to $3 million as a result of certain manipulated CPT codes. Akula received $223,601 for medically unnecessary physician services; $2,281,251 based on history and physical forms that were hand-copied by members of his family for the work of physicians not employed by Canon Healthcare and not billable in a hospice setting; and $316,384 for home visits even though he did not make home visits, the patients were not hospice eligible, and the services he alleged were already included in the daily hospice benefit.

Akula now faces a maximum sentence of 10 years in prison on each count of health care fraud. Akula also faces fines up to $250,000 and supervised release after his prison term is served. After Akula’s conviction was announced, Douglas A. Williams, Jr., Special Agent in Charge for FBI New Orleans, commented that “Mr. Akula took advantage of the American taxpayer by billing for services that weren’t medically necessary, and in some cases, didn’t happen at all [and] [t]he FBI will continue its work to uncover fraudulent schemes like this that take advantage of people when they are most vulnerable.”

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection health care fraud investigations and litigation. If you need assistance with such a matter, please contact us today.