Democrat and Chronicle
Perinton psychiatrist sentenced to 18 months in prison for health care fraud
By Will Cleveland
December 10, 2020
Psychiatrist Muhammad Cheema
A Perinton psychiatrist convicted of health care fraud and making false statements about health care matters was sentenced to 18 months in federal prison Wednesday.
Dr. Muhammad Cheema, 47, who operated Upstate Psychiatry at 115 Sully’s Trail, pleaded guilty in June. He was also ordered by U.S. District Judge Charles J. Siragusa to pay $813,495.48 in restitution to the health care benefit programs he defrauded.
Between 2013 and 2017, Cheema submitted 5,000 false claims for therapy services he did not provide.
Cheema worked for Rochester Regional Health from 2004 until he resigned of his own accord in January 2017. He also worked for various nursing homes, which were not identified in the criminal complaint. Cheema was licensed to practice in New York in August 2004, according to the state Department of Health.
As a result of these false claims, Cheema received $218,368 from various health care benefit programs operated by Excellus, MVP and others. He also created false medical records to substantiate the fraudulent charges.
According to the U.S. Attorney’s Office, the FBI and the state Department of Financial Services began an investigation after Excellus BlueCross BlueShield reported that Cheema allegedly changed office billing codes, billed phone appointments as office visits and regularly had 30 or more patients a day, despite office hours from 11 a.m. to 5 p.m.
Cheema was not board certified in psychiatry as he claimed to be in order to participate with Excellus, according to the criminal complaint.
Investigators performed video surveillance of Cheema’s office. They also examined his patient records, examined his computers, obtained video and audio from an undercover agent, and conducted interviews with his patients from July 2012 to June 2018.
An audit by Excellus on eight patients over a six-month period in 2015 showed overpayment of 54% for services not provided and for improper coding of office visits.
Cheema routinely billed the highest level of evaluation and management services for new patient visits, and his medical notes lacked the documentation to support the level of evaluation and management for established patients.
According to the FBI, an analysis of claims data from January 2013 to December 2015 showed approximately 81 days in which Cheema had more than 10 hours of billed office time for Excellus members alone.
An undercover FBI agent who wore covert audio and video equipment visited Cheema on a few occasions. The agent presented an Excellus insurance card and used cash for the copayment. The complaint alleged that at the first appointment, Cheema did not perform a physical exam or conduct psychotherapy but prescribed two medications.
None of the six appointments lasted more than 20 minutes and Cheema did not do a physical or conduct psychotherapy.