An Assam-born psychiatrist and former CEO of Sovereign Health Group, has been arrested in the United States for his alleged role in a ₹1,240 crore (approx. $149 million) healthcare fraud scheme. U.S. federal prosecutors accuse him of submitting false insurance claims, providing kickbacks, and using illegal marketing tactics between 2010 and 2017.
Accused of Orchestrating Massive Insurance Scam
Tonmoy Sharma, a 61-year-old native of Guwahati, Assam, and former CEO of the now-defunct Sovereign Health Group, was arrested on May 29 at Los Angeles International Airport. He faces an eight-count federal indictment alleging his involvement in a ₹1,240 crore (approx. $149 million) healthcare fraud scheme in the United States.
Sharma is charged with four counts of wire fraud, one count of conspiracy, and three counts of illegal remunerations for referrals to clinical treatment facilities. If convicted, he could face up to 20 years in federal prison for each wire fraud count, five years for the conspiracy count, and up to 10 years for each illegal remuneration count.
Fraudulent Billing and Kickbacks Uncovered
Between 2014 and 2020, Sharma allegedly directed Sovereign Health employees to submit fraudulent insurance claims for unnecessary urinalysis tests, generating over ₹242 crore (approx. $29 million) in false reimbursements. The company also paid more than ₹175 crore (approx. $21 million) in illegal kickbacks to patient brokers to secure referrals, disguising these payments as legitimate marketing expenses.
Investigations reveal that Sovereign Health enrolled patients into insurance plans without their knowledge, using deceptive tactics. Employees misrepresented that treatments would be funded by a foundation, and in some cases, impersonated patients to obtain insurance coverage. The company then billed insurers for unauthorised tests, including comprehensive panel testing, often without physician approval.
Sharma’s co-defendant, Paul Jin Sen Khor, who served as Sovereign’s cash management and accounts payable supervisor, was also arrested. Khor has pleaded not guilty, with his trial set for July 29.
The case is being investigated by the FBI, the U.S. Department of Health and Human Services Office of Inspector General, and the California Department of Health Care Services. Sharma is currently in federal custody awaiting arraignment.
About the Author – Anirudh Mittal is a B.Sc. LL.B. (Hons.) student at National Forensic Sciences University, Gandhinagar, with a keen interest in corporate law and tech-driven legal change.