Nurse practitioner in Texas sentenced to 20 years for multi-million dollar fraud

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Waxahachie, TX nurse practitioner Trivikram Reddy was sentenced May 25, 2021, to 20 years in federal prison and ordered to repay more than $52 million in restitution for his role in a health care fraud conspiracy, announced Acting U.S. Attorney for the Northern District of Texas Prerak Shah.

Reddy, 39, pleaded guilty to conspiracy to commit wire fraud in October 2020.  He was sentenced by U.S. District Judge Ada Brown.

“Mr. Reddy engaged in a scheme that defrauded Medicare and private insurance providers out of millions of dollars,” said Acting U.S. Attorney Shah in a May 26 press release.  “The Justice Department will continue to aggressively prosecute all types of health care fraud to protect the integrity of our health care system and ensure that criminals are held accountable.”

According to court documents cited from in the press release, Reddy, a licensed nurse practitioner, devised a scheme to defraud Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana, and Cigna.

Reddy and co-conspirators created false patient bills using the provider numbers of six doctors as the treating physicians on the claims.  All the claims were false and at no time did the six doctors provide billable services to any of Reddy’s medical clinics.

On June 3, 2019, federal agents served a civil investigative demand at one of Reddy’s medical clinics. When law enforcement arrived at the site, agents found Reddy’s staff manufacturing medical records, the press release said.  Reddy closed the clinic on June 8, 2019, and terminated his business entity with the Texas Secretary of State.

On June 13, 2019, he made the first of multiple wire transfers which, in sum, totaled more than $55 million.  A forensic financial analysis directly tied the money to fraudulent health care claims submitted by Reddy.

Federal agents requested medical records to justify millions of dollars of paid Medicare claims paid between January 2014 and June 2019.  Reddy and his staff spent the next four months manufacturing fake medical records to turn over to authorities.