Guwahati: Assam’s Tonmoy Sharma, now based in California, USA, has been arrested for allegedly submitting over $149 million in fraudulent insurance claims between 2014 and 2020.
Sharma, the founder and former CEO of the now-defunct Sovereign Health Group, a prominent addiction treatment provider, was arrested on May 29 at Los Angeles International Airport on an eight-count federal grand jury indictment.
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According to a statement released by U.S. Attorney’s Office, Central District of California, the indictment alleges Sharma orchestrated a sprawling healthcare fraud scheme, submitting over $149 million in fraudulent claims to health insurers, including for unneeded urinalysis tests, and paying more than $21 million in illegal kickbacks for patient referrals.
Sharma, now a resident of Tustin, California, originally hails from Bamunimaidam in Guwahati. He is the eldest son of the late Phani Sarma and elder brother of Chinmoy Sharma, owner of the Anuradha cinema.
He is charged with four counts of wire fraud, one count of conspiracy, and three counts of illegal remunerations for referrals to clinical treatment facilities.
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If convicted, Sharma faces a statutory maximum sentence of 20 years in federal prison for each wire fraud count, five years for the conspiracy count, and up to 10 years for each illegal remunerations count.
According to the indictment, from 2014 to 2020, San Clemente-based Sovereign Health Group, which operated across Southern California and several other states, aggressively pursued patients, often billing private insurance companies at high, out-of-network rates.
Under Sharma’s direction, Sovereign employees allegedly employed deceptive tactics to enroll patients, including misrepresenting that treatment would be funded by a sham foundation.
This foundation was purportedly a ruse to obtain patient information to surreptitiously secure health insurance coverage on their behalf, often by making false representations on insurance applications to exploit Affordable Care Act loopholes.
Patients were frequently unaware that Sovereign would enroll them in these policies, with employees at times even impersonating patients when contacting insurance companies.
The indictment further alleges that Sovereign fraudulently billed insurers over $29 million for urinalysis tests, including comprehensive panel testing, that were not authorized by healthcare providers.
Sharma is accused of directing employees to frequently administer these tests, often up to three times a week, and submitting thousands of claims for tests purportedly authorized by physicians who had not done so, or who were no longer even employed by Sovereign.
Beyond the fraudulent billing, Sharma is accused of procuring patients by paying over $21 million in illegal kickbacks to patient brokers. To conceal these illicit payments, sham contracts disguised the brokers’ services as “marketing hours.”
The FBI, the United States Department of Health and Human Services Office of Inspector General, and the California Department of Health Care Services are investigating this matter, the statement said.
The California Department of Insurance, the United States Department of Labor Employee Benefits Security Administration, the Office of Personnel Management Office of Inspector General, and IRS Criminal Investigation provided substantial assistance in the investigation, it added.
Assistant United States Attorney Solomon Kim of the Major Frauds Section is prosecuting this case.