Psychiatrist Convicted for Defrauding Insurers of Over $10 Million
After a seven-day trial, a Federal jury found a Natick psychiatrist, Gustavo Kinrys, 52, guilty on thirteen of the fourteen counts against him, alleging wire fraud and false statements relating to health care matters. The trial involved Kinrys having fraudulently billed private insurers and Medicare for over $11 million for psychiatric procedures that he never provided to patients.
U.S. District Court Judge Denise J. Casper has scheduled sentencing for January 31, 2023.
Indicted in 2020 for falsely billing private insurers and Medicare over $11 million
Kinrys had originally been indicted and arrested in December 2020 for allegedly billing Medicare and private insurance companies over $11 million for medical treatments he never actually provided.
Transcranial magnetic stimulation (TMS) therapy
Kinrys was a licensed psychiatrist who owned and operated Advanced TMS Associates, located in Natick. One of the services Kinrys’ company offered was transcranial magnetic stimulation (TMS) therapy 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.
Over $10 million billed to insurers for TMS treatments that never occurred
Most insurance companies cover TMS therapy costs since it is FDA-approved for the treatment of major depressive disorder. However, during its investigation, the government discovered that Kinrys had billed for thousands of transcranial magnetic stimulation (TMS) therapy sessions that never occurred.
The government’s evidence proved that Kinrys billed Medicare and insurers $10.6 million for more than 8,000 TMS sessions he claimed to have provided to 74 patients – who never received even a single session.
Over 1000 psychiatric sessions were claimed while Kinrys vacationed
In addition to phantom TMS treatments, Kinrys also billed hundreds of thousands of dollars worth of psychotherapy sessions that never took place. Prosecutors alleged and proved he submitted claims for over 1,000 in-person counseling sessions supposedly taking place while he was out of the country on vacation destinations like the Bahamas, Dominican Republic, and the Czech Republic.
Billing for more than 24 hours of psychotherapy sessions in a day
On 382 occasions, the government’s evidence showed that Kinrys billed insurers for providing over 24 hours of psychotherapy services in a single day. His largest claim for a day’s work was providing 70 individual hour-long counseling sessions in one day. That day of intense counseling allegedly occurred while Kinrys was abroad on vacation.
Fabricated records to hide fraud
Based on Kinrys’ activities in disguising his fraud by carefully scrutinizing billing codes and services that raise less suspicion when billed excessively, his scam went on for years undetected.
To document the bogus treatments, Kinrys allegedly fabricated medical records and made false chart notes. He instructed his office staff to create fake documentation showing patients improved after receiving the phantom care. Some patients were unaware that Kinrys billed for services they never got. Others told investigators they only received a fraction of the treatments for which he billed the insurers and Medicare.
Trial and conviction
Kinrys’ trial lasted seven days and ended on October 24, 2023.
Over the course of the trial, prosecutors called twenty witnesses to the stand, including former patients of Kinrys, insurance company representatives, billing auditors, and former staff members from his practice.
Some key evidence and testimony consisted of the following:
Patient medical records showing treatments billed for but never documented.
Kinrys’ flight and hotel receipts proving he was out of the country on dates he claimed to be providing therapy.
Testimony from patients saying they never received the number of treatments billed for.
Witnesses from his practice describing being instructed to falsify documentation.
After five days of presenting witness testimony and documentary evidence, both sides rested, gave closing arguments, and the judge charged the jury. After less than a day of deliberations, the jury returned guilty verdicts on 13 of the 14 counts – the seven wire fraud charges and six false statement charges. Kinrys was found not guilty on one count of obstructing an investigation.
Judge Casper continued Kinrys on his recognizance over the objections of the prosecutors who argued for Kinrys’ immediate incarceration pending his sentencing hearing.
The Potential Penalties
Each wire fraud conviction carries a maximum sentence of 20 years in prison, a $250,000 fine, or twice the gross gain or loss, whichever is greater, and three years of supervised release.
The false statement charges have a maximum penalty of 5 years in prison, a $250,000 fine or twice the gross gain or loss, whichever is greater, and three years of supervised release each.
Kinrys’ sentencing is scheduled for January 2024.
Before U.S. District Judge Denise Casper sentences Kinrys in January, prosecutors will submit a sentencing memorandum with their sentencing recommendations based on the Federal Sentencing Commission Guidelines. Based on the factors in the sentencing guidelines that Kinrys’ criminal acts checked off, the Federal prosecutors will undoubtedly recommend a hefty prison sentence.
The defense attorneys will likewise submit Kinsyr’s memorandum in support of their reading of the sentencing guidelines and any mitigating facts or personal submissions that might lessen the impact of the sentencing guidelines. However, based on the evidence presented in the indictment and proven in Dr. Kenrys’ jury trial, these lawyers have their work cut out for them.
The prosecution team
The prosecution team representing the United States announcing Gustavo Kinrys’ conviction consisted of Acting U.S. Attorney Joshua S. Levy, Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services Office of the Inspector General, FBI Boston Division Special Agent in Charge Jodi Cohen and Anthony DiPaolo. Executive Director at the Insurance Fraud Bureau of Massachusetts.
Assistant U.S. Attorneys Patrick M. Callahan and Christopher R. Looney of the Health Care Fraud Unit represented the United States for the trial proceedings.
