Shiva Akula, 65, the owner of New Orleans-based hospice facility Canon Healthcare has been indicted by a grand jury for 23 counts of health care fraud for allegedly billing Medicare for services that were not medically necessary or were not provided at all.

The U.S. Department of Justice has accused Akula of instructing Canon staff to bill for general inpatient care (GIP) for hospice patients who did not need that level of service. The indictment also alleged that Canon routinely billed Medicare for physician services for patients who were admitted into GIP and stayed for longer than 24 hours.

According to the Justice Department, the company filed those claims using billing codes that are only appropriate when a patient is admitted to an inpatient hospital for a minimum of eight hours, but less than 24 hours and discharged on the same calendar day.

“Canon submitted approximately 1,053 claims for [Common Procedural Terminology (CPT)] code 99236 and was paid approximately $223,601 by Medicare. During that same time period, Canon submitted approximately $2,281,251,” the Justice Department indicated in a statement. “These physician services reflected in CPT Codes 99236 and 99233 should not have been billed as a separate line item in addition to the GIP services because they were included within the daily per diem rate that Medicare paid for the GIP services.”

When a provider applies that billing code, physicians are required to identify that they were physically present and performed the initial hospital care service. The physician also must personally document the admission and discharge notes and include the number of hours the beneficiary remained in inpatient hospital status. Canon did not comply with these rules, according to the indictment.

In addition, prosecutors claim that between Jan. 2013 and Aug. 2017, Canon submitted Medicare claims for nearly 1,949 home visits by physicians, when doctors did not actually perform the visit. Canon received more than $316,000 in reimbursement for those claims, the Justice Department reported.

U.S. Attorney’s emphasized that the indictment did not represent a conviction and that the charges must be proven beyond a reasonable doubt in a court of law. If convicted, Akula could receive a sentence of as many as 10 years in prison and maximum fines of $250,000, as well as a mandatory special assessment of $100 per count.

The case was investigated by the Federal Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, and the Louisiana Department of Justice, Medicaid Fraud Control Unit investigated the case. Assistant U.S. Attorney Kathryn McHugh is prosecuting.