Telemedicine Nurse Practitioner Pleads Guilty to $7.8 Million Durable Medical Equipment Fraud Scheme
BOSTON – A Natick psychiatrist was convicted by a federal jury yesterday of billing Medicare and private insurance companies for over $11 million in treatments he did not provide and obstructing justice in an attempt to conceal his crimes.
Gustavo Kinrys, 52, of Wellesley, was convicted of seven counts of wire fraud, six counts of false statements relating to health care matters and one count of obstructing a criminal health care investigation. U.S. District Court Judge Denise J. Casper scheduled sentencing for Jan. 31, 2023. Kinrys was arrested and charged in December 2020.
“Dr. Kinrys shamelessly billed for over $11 million in treatment from Medicare and private insurers – treatments he never provided. He exploited our healthcare system and showed callous disregard for patient well-being,” said Acting United States Attorney Joshua S. Levy. “This conviction should send a stern message: healthcare fraud will not go unpunished, and those who exploit our vital healthcare system for personal gain will face the full extent of the law.”
“Through his scheme to defraud the Medicare program, the defendant stole taxpayer funds and violated the public’s trust in his position as a physician,” said Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General. “This conviction sends a clear message that we will hold accountable those who exploit our federal health care system for personal gain, and we will not tolerate attempts to obstruct our pursuit of justice.”
“This conviction is a big win for taxpayers who were cheated when Dr. Kinrys fraudulently billed Medicare and private insurance companies for more than $11 million for medical treatments he never provided and then obstructed our investigation in an attempt to conceal his crimes,” said Jodi Cohen, Special Agent in Charge of the FBI Boston Division. “Healthcare fraud is not a victimless crime. It can raise health insurance premiums, expose patients to unnecessary medical procedures, and increase taxes. Anyone involved in, or entertaining similar activity, should know the FBI and our partners will not hesitate to pursue those trying to steal from our country’s vital health care system.”
“This matter illustrates the commitment of all agencies to combat medical billing fraud which affects all citizens. The Insurance Fraud Bureau of Massachusetts places a high priority on fighting this type of insurance fraud. Our continuing collaboration with our partners is critical to successfully fight insurance fraud,” said Anthony M. DiPaolo, Executive Director of the Massachusetts Insurance Fraud Bureau.
Kinrys was a licensed psychiatrist who owned and operated Advanced TMS Associates, located in Natick, Mass. Among other services, Kinrys offered transcranial magnetic stimulation (TMS) therapy and psychotherapy to patients suffering from depression. TMS therapy is a noninvasive method of brain stimulation that uses rapidly alternating or pulsed magnetic fields to induce electrical currents directed at a patient’s cerebral cortex.
Between January 2015 and December 2018, Kinrys engaged in a variety of fraudulent billing schemes in which he sought and received reimbursement for services he did not render. For example, Kinrys billed Medicare and private insurers $10.6 million for thousands of TMS sessions he never provided, including over 8,000 sessions he claimed were provided to 74 patients who, in fact, never received a single session of the therapy. Kinrys billed Medicare and private insurers for hundreds of thousands of dollars’ worth of psychotherapy sessions he never provided, including over 900 face-to-face sessions he falsely claimed he provided while he was on vacation in locations like the Bahamas, Punta Cana, Dominican Republic, and the Czech Republic. On 382 occasions, Kinrys billed Medicare and private insurers for having provided more than 24 hours’ worth of psychotherapy services in a single day, including one day in July 2017 when he claimed he had provided hour-long psychotherapy sessions to 70 different patients – all while outside the United States on vacation.
To further his fraudulent billing scheme, Kinrys made numerous false statements to his patients, the billing company with which he worked and the insurers to whom he submitted claims seeking reimbursement. When Medicare, private insurers and the Department of Health and Human Services (HHS) sought records from Kinrys pertaining to certain of his claims, he took steps to conceal his fraudulent conduct by making false representations and creating false documentation purporting to show that he had provided thousands of treatments he had billed for, but never rendered. For example, in response to a July 2018 subpoena from the HHS’s Office of Inspector General seeking medical records for 10 of his patients, Kinrys created documents – and ordered his office workers to create documents – falsely stating that those patients had received dozens of treatments they had never been provided and falsely representing that the condition of those patients was improving.
The wire fraud charges provide for a sentence of up to 20 years in prison, three years of supervised release and a fine of $250,000 or twice the gross gain or loss, whichever is greater. The charges of false statements relating to health care matters and obstruction of a criminal investigation of a health care offense each provide for a sentence of up to five years in prison, three years of supervised release and a fine of $250,000 or twice the gross gain or loss, whichever is greater. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and statutes which govern the determination of a sentence in a criminal case.
Acting U.S. Attorney Levy, HHS-OIG SAC Coviello, FBI Boston SAC Cohen and MA IFB Director DiPaolo made the announcement today. Assistant U.S. Attorneys Patrick M. Callahan and Christopher R. Looney of the Health Care Fraud Unit are prosecuting the case.