Dr. Muhammad A. Cheema is alleged to have billed for services not provided

The FBI used an undercover agent to gather evidence for the charges

Cheema also was allegedly paid more than $855,000 by pharmaceutical companies

A Pittsford psychiatrist has been charged with health care fraud and making false statements about health care matters.

Dr. Muhammad A. Cheema, 45, was charged Monday by the U.S. Attorney for the Western District of New York.

Cheema operates Upstate Psychiatry at 115 Sully’s Trail. Cheema worked for Rochester Regional Health from 2004 until he resigned of his own accord in January 2017, according to a spokeswoman for the health system. He also worked for various nursing homes, which were not identified in the complaint. Cheema was licensed to practice in New York in August 2004, according to the state Department of Health.

Cheema also represented pharmaceutical companies between August 2013 and December 2016, according to the U.S. Attorney.

If convicted of the federal charges, he could face up 10 years in prison and a $250,000 fine.

Cheema appeared Monday before Judge Marian Payson. He is scheduled to return to federal court in Rochester at 9:30 a.m. Sept. 25.

According to the U.S. Attorney's Office, the FBI and the state Department of Financial Services began an investigation after Excellus BlueCross BlueShield reported that Cheema allegedly changed office billing codes, billed phone appointments as office visits and regularly had 30 or more patients a day, despite office hours from 11 a.m. to 5 p.m.

The complaint also alleges that Cheema was not board certified in psychiatry as he claimed to be in order to participate with Excellus.

The 18-page complaint described the video surveillance of Cheema’s office, his patient records, examination of his computers, video and audio from an undercover agent and interviews with patients of the practice from July 2012 through June 2018.

An audit by Excellus on eight patients over a six-month period in 2015 showed overpayment of 54 percent for services not provided and for improper coding of office visits. According to the charges, Cheema routinely billed the highest level of evaluation and management services for new patient visits, and his medical notes lacked the documentation to support the level of evaluation and management for established patients.

According to the FBI, an analysis of claims data from January 2013 to December 2015 showed approximately 81 days in which Cheema had more than 10 hours of billed office time for Excellus members alone. This analysis did not include billing from any other insurer.

According to the complaint, the FBI conducted video surveillance of Cheema’s practice on multiple days over several months. The complaint stated that Cheema falsely reported the time he spent seeing patients. The actual time spent with them was not long enough to get a medical history, perform a physical exam and psychotherapy necessary to support what he billed.

The FBI also used an undercover agent who wore covert audio and video equipment. The agent presented an Excellus insurance card and used cash for the copayment. The complaint alleged that at the first appointment, Cheema did not perform a physical exam or conduct psychotherapy but prescribed two medications. None of the six appointments lasted more than 20 minutes and Cheema did not do a physical or conduct psychotherapy.

In addition to his private practice, Dr. Cheema was paid over $855,000 by multiple pharmaceutical companies for 341 promotional speaking engagements and 62 consulting opportunities between August 2013 and December 2016.

In 2011, the Democrat and Chronicle investigated payments by pharmaceutical and medical device companies to Rochester doctors. According to the data, Cheema was the highest earner, receiving $221,304 from five pharmaceutical companies for speaking engagements, travel and meals.

PSINGER@Gannett.com