Assam-born doctor arrested in US for orchestrating $149 million healthcare scam

Guwahati, June 5: A 61-year-old native of Assam and former CEO of the now-defunct Sovereign Health Group, was arrested at Los Angeles International Airport (LAX) on an eight-count federal indictment linked to a massive healthcare fraud scheme in the United States.

Tonmoy Sharma, who reportedly earned his MBBS from Assam Medical College in 1987 before moving to the US, is accused of orchestrating a complex fraud operation that involved submitting over $149 million in false claims to private health insurers and paying more than $21 million in illegal kickbacks for patient referrals.

Known as at the pioneer in schizophrenia research and treatment in earlier years, Sharma held medical licences in both India and the UK. However, the indictment now paints a picture of systemic abuse of the healthcare system.

Sharma’s co-defendant, Paul Jin Sen Khor, 45, who oversaw cash management at Sovereign, was also arrested.

Khor faces charges of conspiracy and offering illegal remuneration, disguised as "marketing hours".  Eventually, he has pleaded not guilty and was released on bond.

If Sharma is convicted, he will face a statutory maximum sentence of 20 years in federal prison for each wire fraud count.

In addition both the defendants would face up to five years in federal prison for conspiracy and 10 years for illegal remunerations count.

According to reports, Sovereign Health allegedly overbilled insurers between 2014 and 2020 and used aggressive, misleading tactics to recruit patients.

As per the indictment, Sharma directed staff to lure patients under false pretences and set up a sham foundation to collect personal data—including names, dates of birth, and Social Security numbers—to fraudulently enroll individuals in private insurance plans.

To secure coverage outside official enrolment periods, Sovereign employees, under Sharma’s instruction, made false declarations on insurance applications.

These included inventing qualifying life events and manipulating income figures so that patients would qualify for government-subsidised insurance under the Affordable Care Act, which offered significantly higher reimbursement rates than Medicaid.

Sovereign submitted over $29 million in fraudulent claims to insurers for unauthorised urinalysis tests.

Notably, at Sharma's direction, the company billed for comprehensive urinalysis screenings, including through its lab, Vedanta Laboratories Inc., without authorisation from healthcare providers.

Meanwhile, the case is currently under investigation by the FBI, the US Department of Health and Human Services Office of Inspector General, and the California Department of Health Care Services.

With inputs from agencies