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Navigator: Medicare Fraud ˇ

The Banknote Mill of Drs. Nayar, Khan, Dangor & Datta

Evidence:  Statement of Practitioner Services

Did the MCIB Fulfill its Ruling for the Nayar Fraud?

2007 – MCIB Ruling
Source: Perry Behl Letter
2016 – Evaluation a Decade Later
Source: Nayar Fraud: Statement Update 2016(sidebar, right)

Policy 1

The inappropriate billings ceased effective Jan/07.

Actualized

The Nayar fraud did cease in January 2007.

Policy 2

While there has been a recovery of funds … our systems do not allow for removal of claims that have been paid to physicians.

Actualized

All the illicit billings remain on the Statement. The MCIB was open about its surreal policy in 2007 which should have matured in a decade. The Statement, after all, has more than a financial purpose.

Our sidebar (right) offers statistics:  A standard Statement page has 37 entries meant to portray the real medical history of a patient. But during the four years of the Nayar era, the number of phantom appointments on each page ranges from 17 to 29 an error rate of 45% to 78%.

Policy 3

We have noted in your situation that some claims were inappropriate.

Evaporated

On the updated Statement of 2016, the illicit billings are not marked or identified in any way. There is not even a general note to warn readers to disregard claims referencing Drs. Nayar, Khan, Dangor & Datta.

Ruling from MCIB, Saskatchewan Health

· Drs. Nayar, Khan, Dangor, and Datta Repay Funds Obtained via Fraud
· Billing Record Still Interleaves 134 Fake Appointments with Legit Ones

November 15, 2007

Ms. Georgena Sil
P.O. Box 1491
SASKATOON  SK S7K 3P7

Dear Ms. Sil:

Thank you for your letters dated October 18, 2007, following up on concerns you raised in 2006 relating to specific physician billings that appear on your Statement of Physician Services, and October 21, 2007, requesting a copy of your Statement of Physician Services.

As a result of the Department’s review of your concerns, the billings identified as inappropriate ceased effective January 15, 2007. The Statement of Physician Services provided to you on March 8, 2007 and the statement attached, show that the last inappropriate billing occurred in January 2007. Saskatchewan Health has successfully worked with the physicians involved on the recovery of inappropriately paid amounts.

While there has been a recovery of funds, your Statement of Physician Services will continue to reflect all payments made to the physicians. Our systems do not allow for the removal of claims that have been paid to physicians; however, we have noted in your situation that some claims were determined to be inappropriate.

Thank you again and I trust that your concerns relating to the physician billings have been addressed.

Yours truly,

Perry Behl
Director
Professional Review & Quality Management

Attachment

Letter #2 to Saskatchewan Health / Medical Care Insurance Branch

· Updated Billing Statement Shows:  Initial 95 Fake Claims Not Yet Prosecuted
· Instead, Scam Barrels Ahead:  Dr. Nayar Claims 39 More Fake Appointments

Dr. Arun Nayar:  Cover Letter Attached to His Medical Chart

· Nayar Admits that Only 2 Appointments Actually Took Place

Letter from College of Physicians and Surgeons of Saskatchewan

· CPSS Assists in Obtaining Medical Chart from Dr. Nayar

CPSS Seal

REGISTRAR:
D.A. KENDEL, M.D.

College of
Physicians and Surgeons
of Saskatchewan

G.W. PEACOCK BUILDING,
211 - FOURTH AVE. SOUTH,
SASKATOON, SK  S7K 1N1

Business: (306) 244-7355
Fax: General (306) 244-0090
Fax: Dr. Kendel (306) 244-2600
email: cpss@quadrant.net
www.quadrant.net/cpss

OUR FILE:

February 27th, 2007

Ms. Georgena Sil
Box 1491
Saskatoon, SK S7K 3P7

Dear Ms. Georgena Sil,

The College of Physicians and Surgeons acknowledges the copy of your letter requesting medical records from Dr. A. Nayar.

The physician's office may require a fee for providing the medical record requested, according to the Saskatchewan Medical Association Relative Value Guide and Fee Schedule for Uninsured Services.

Sincerely,

Virginia Marsh
Regulatory Services Coordinator
College of Physicians & Surgeons of Saskatchewan

cc:  Dr. A. Nayar

VGM/vgm

Competent caring Physicians providing quality health care.

Chart Request Addressed to Dr. Nayar at Medical Arts Building

· Clinical Notes:  Concrete Proof of Patient’s Appointment Schedule

Letter from Saskatchewan Health, Medical Care Insurance Branch

· College Forwarded Formal Complaint to MCIB / Investigation Begun

May 26, 2006

Ms. Georgena Sil
214 Whitecap Crescent
SASKATOON SK S7M 5C7

Dear Ms Sil:

The College of Physicians and Surgeons of Saskatchewan has forwarded a copy of your complaint filed with them detailing our concerns regarding billing of services by Doctors Nayar, Khan, and Dangor.

Please be advised that the Medical Services Branch is in the process of investigating your complaint and allegations with the physicians in question. In the interim we have noted your file that the services in question are under investigation.

You may be interested in knowing the particular service code billed on your behalf is described as a routine visit to a nursing home. The actual payment schedule description of this particular item is a visit on a regular basis to a patient to provide an examination, assessment or evaluation of the patient's condition; advice as necessary to the patient and/or the nursing staff concerning management of the patient.

Thank you for your concern with the billing information you received from the Medical Services Plan.

Sincerely,

Brad Havervold
Executive Director

cc:Karen Shaw, Deputy Registrar, CoPSS
Doug Trew, Director, MSB

Letter from College of Physicians and Surgeons of Saskatchewan

· Response to Formal Complaint:  Forward Billing Info to MCIB

CPSS Seal

REGISTRAR:
D.A. KENDEL, M.D.

College of
Physicians and Surgeons
of Saskatchewan

G.W. PEACOCK BUILDING,
211 - FOURTH AVE. SOUTH,
SASKATOON, SK  S7K 1N1

Business: (306) 244-7355
Fax: General (306) 244-0090
Fax: Dr. Kendel (306) 244-2600
email: cpss@quadrant.net
www.quadrant.net/cpss

OUR FILE:

May 5, 2006

Ms. Georgena Sil
P.O. Box 1491
SASKATOON, SK  S7K 3P7

Dear Ms. Sil:

As Medical Manager of the Complaints Resolution Advisory Committee, I have reviewed the complaint you have lodged against a number of physicians with respect to allegations of inappropriate billing.

The Medical Services Branch of Saskatchewan Health is the paying agency for services. They will have an interest in this information and can order reassessments within certain time periods if necessary. The information has been forwarded to them for their review with the exception of the consult letter from Dr. Taranger, operative report concerning your cystoscopy, and the letter from Dr. Jonat. These documents have been removed to protect your privacy. If you feel they are important documents that the Medical Services Branch should have in the review of your complaint, please provide them copies.

Our complaints process will not be reviewing this matter at this time. The College has requested to be informed at the conclusion of the Medical Services Branch's review, and if appropriate, will review the matter at that time.

Sincerely,

Karen Shaw, M.D.
Medical Manager
Complaints Investigation and Resolution Process

KS/mcd

Competent caring Physicians providing quality health care.

Formal Complaint to College of Physicians and Surgeons

· Excerpt Below Conveys Substance of Complaint  /  Go to: Full Complaint (PDF)

GEORGENA SIL MARCH 22, 2006

7. Provide a brief and clear description of the complaint(s) you have about the physician(s) named in the complaint. Include examples where appropriate (e.g. if you are alleging rude behavior, provide an example).  (If a letter of complaint has been received by the College, it will be attached to this form. You may add additional information as necessary.)

Recently I applied to Sask Health for a billing statement, simply to update my files at home. The statement was printed March 2/06.  When it arrived I was stunned to see that four GPs had committed financial fraud on a massive scale.

Altogether, these GPs billed $1,956 for a series of 95 appointments which did not exist. Refer to detailed analysis attached. To summarize the excess fees claimed by each GP:

Dr. Nayar 21   visits 450.00   excess
Dr. Khan 44   visits 882.00   excess
Dr. Dangor 28   visits 582.00   excess
Dr. Datta 2   visits 42.00   excess

As house physicians to McCoshen Care Home, these GPs make rounds of their patient-group every two weeks, and attend to emergencies when called. But this involves only about 50% of the Care Home residents.

The remaining residents choose their own GP outside of (and independent of) the Care Home. I am in this category. When I moved into the Care Home in August/03, my choice of GP was in transition. Dr. Nayar and Dr. Khan assisted me briefly. Then during 2004-05 I consulted only GP Dr. Balakrishna and later Dr. Straza.

The false claims from Drs. Nayar, Khan, Dangor and Datta began in the autumn of 2003 and continued steadily until Feb/06, which is just before the billing statement was printed. This fraud is active and is still ongoing.

The dollar amount of the fraud concerns me. But equally, I am concerned about the assault to my good reputation. The 95 fictitious appointments make me appear absurd, as if I made a hobby of visiting a new GP each week.

8. What is your expectation from the investigation of this complaint?

(1) To require Drs. Nayar, Khan, Dangor, and Datta to reimburse $1,956 to Sask Health.  (2) To prepare a streamlined billing statement for me with the 95 false claims removed.

  Additional Comments

Statute of Limitations
Most citizens are not aware they can obtain a Statement of the fees billed against their health number. Those who are aware, often obtain it too late. This was my experience in 1995-96 at Pleasant Hill Plaza Medical Centre (documents attached). There is a two-year limit period for financial reassessment. Within that timeframe, Saskatchewan citizens should automatically receive their personal billing data for review.

Letter #1 to Saskatchewan Health / Medical Care Insurance Branch

· Drs. Nayar, Khan, Dangor & Datta Bill for 95 Non-Existent Appointments

Initial Report to the Saskatoon Police Department:  A Citizen’s Duty

· Dr. Nayar Fraud / At this Point, the Phantom Appointments = 95
· Report Forwarded to the Saskatoon District Prosecution Office

Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia
TuumEstContact@protonmail.com
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Kush / Departure of the Winged Ship

Departure of the Winged Ship (Kush)

Things gained through unjust
fraud are never secure

Sophocles (496-406 BC)

Medical Arts Building, Saskatoon
×

Medical Arts Building

Dr. A. Nayar Medical Prof. Corp.
125-750 Spadina Crescent East
Saskatoon, Saskatchewan
Canada  S7K 3H3

Nayar group at time of fraud
Physician Medical School
Dr. Arun Nayar Mysore, India
Dr. Rukhshanda Khan Karachi, Pakistan
Dr. Abdulla I. Dangor Ireland
Dr. Jyotirmoy Datta Calcutta, India

Medical Arts Building
750 Spadina Crescent E, Saskatoon

NAYAR FRAUD: THE EVIDENCE

The patient, Tuum Est webmaster Georgena Sil, applied to Sask Health for her Statement of Practitioner Services covering the period from September 2003 to January 2007.

The Statement showed systematic billing fraud by the GP group Drs. Nayar, Khan, Dangor, and Datta at the Medical Arts Building, Saskatoon.

The Statement is six pages long. A mere two pages would suffice for the medical services that actually occurred. The grand totals are:

196 = Total claims on the Statement
 58 = Legitimate claims
134 = Fraudulent claims
  4 = Null claims

The evidence for the billing fraud is concrete and irrefutable, and consists of:

  • Statement of Practitioner Services for the period September 2003 to January 2007. It lists all the medical services which physicians billed for patient Georgena Sil.
  • Dr. Nayar's full medical chart for Sil (two pages long, recording two appointments).
  • Dr. Nayar's cover letter, addressed to Sil and sent with the chart, which contains a confession: Knowing the College and MCIB had reviewed the chart, Nayar had no choice: He admitted that all but two of his billed appointments were phantom.

The evidence appears below. Click an image for a large readable view.

Dr. Nayar Letter

Dr. Nayar's banknote mill collapsed when patient Georgena Sil requested a full copy of her medical chart from that clinic. The chart contained just two pages, reflecting exactly two patient visits.

When sending the chart, Dr. Nayar attached a cover letter addressed to Georgena Sil. He speaks on behalf of his GP partners:

We are enclosing the copy of your medical chart from the only two visits you have made in our clinic dated Sept 16/03 and Sept 26/03. We have not seen you as a client in the Whitecap Care Home and an error has been made concerning the billing.

Probe the euphemism: What Nayar calls an error concerning the billing was in reality a banknote mill: Over four years, the Nayar group churned out 134 claims for phantom appointments, including these paradoxes:

  • Non-acute care on statutory holidays.
  • GP consults placing a single patient at two separate sites (miles apart) on the same day, at the same time.
 
Billing Statement 2007 (p 1)

Each line of the Statement represents one billing from one physician. The Statement is verbatim from the original. We added color to establish the scale of the fraud.

37 = Total claims on this page
20 = Legitimate claims (white background)
17 = Fraudulent claims (gray background)

Billing Statement 2007 (p 2)

37 = Total claims on this page
10 = Legitimate claims (white background)
27 = Fraudulent claims (gray background)
Green identifies a location conflict

During that year, my real GP was Dr. Straza; his billings are correct. He practiced at the Idylwyld Medical Clinic.

The illicit claims are all from the GP group Dr. Nayar, Dr. Khan, Dr. Dangor & Dr. Datta. Their clinic is in the Medical Arts Building.

The two clinics are miles apart in the city of Saskatoon. Yet the Statement puts me in both on the same day, ostensibly receiving the same service (a full examination). The conflict occurs twice on this page:

02/11/2004 – Dr. Khan and Dr. Straza both billed for appointments on this day.

06/11/2004 – Dr. Dangor and Dr. Straza both billed for appointments on this day.

Even if the MCIB computer cannot tell which of two GPs a patient sees, surely it can be programmed to recognize a conflict, and trigger a flag inviting inspection.

Billing Statement 2007 (p 3)

37 = Total claims on this page
8 = Legitimate claims (white background)
25 = Fraudulent claims (gray background)
4 = Null claims (pink background)

The 4 null claims go in pairs, where a claim was billed from Dr. Dangor, then reversed the same day. No explanation was given.

But Dr. Dangor did not reverse everything. On this page, 7 fraudulent claims are his.

Billing Statement 2007 (p 4)

37 = Total claims on this page
8 = Legitimate claims (white background)
29 = Fraudulent claims (gray background)
Yellow identifies a statutory holiday

The MCIB computer which sanctions and prints payment cheques to doctors should not churn so much by rote. The system fails to scrutinize and flag dubious claims.

For four years, the Nayar clinic milked the system; every claim was passed. They even billed for non-emergency consultations on statutory holidays. There are two incidents on this page:

11/11/2005 – Dr. Dangor billed for service code BB on Remembrance Day.

01/01/2006 – Dr. Nayar billed for service code BB on New Year's Day.

The Payment Schedule describes service code BB as: an examination, assessment or evaluation of the patient's condition, and advice as necessary.

Billing Statement 2007 (p 5)

37 = Total claims on this page
 9 = Legitimate claims (white background)
28 = Fraudulent claims (gray background)
Yellow identifies a statutory holiday Green identifies a location conflict

On this page of the Statement, another statutory holiday crops up:

01/07/2006 – Dr. Dangor billed for an office appointment on Canada Day.

Again I am placed in two separate sites miles apart, on the same day, for the same service. The locations are the Medical Arts Building (where Dr. Nayar works), and the Idylwyld Medical Clinic (where my real GP, Dr. Straza, works). To wit:

18/03/2006 – Dr. Khan and Dr. Straza both billed for appointments on this day.

24/07/2006 – Dr. Khan and Dr. Straza both billed for appointments on this day.

Billing Statement 2007 (p 6)

11 = Total claims on this final page
 3 = Legitimate claims (white background)
 8 = Fraudulent claims (gray background)

NAYAR FRAUD: UPDATE 2016

In early 2016, Sil completed a Medical Services Request Application. Sask Health replied with Billing Statements covering the previous ten years (from 2006 to 2016).

Nayar ran his fraud nonstop during 2003-2007. The final year of that era (January 2006 through to January 2007) just makes it onto the fresh Statement.

It is instructive to compare the Statements, past and present, in light of the original MCIB ruling from Perry Behl which said:

There was a recovery of funds. Our systems do not allow for removal of claims … however, we have noted in your situation that some claims were determined to be inappropriate.

Did the MCIB fulfill its promise to annotate the record? In particular:

  • Did the MCIB in any way mark or identify the phantom appointments on the new Statement?
  • Did the MCIB make a general note on the Statement to warn readers to disregard claims from Nayar, Khan, Dangor & Datta?

Answer: no. The Statement is still bloated with phantom claims, with no clarification in sight.

New Statement of Practitioner Services

2016 Statement  (page 1)

2016 Statement  (page 2)

2016 Statement  (page 3)

Other Resources

Stopping the Nayar Fraud: Timeline

Copyright © 2008-2019 Georgena Sil. All Rights Reserved.