Depending on who you believe, the case against Dr. Sreekrishna Cheruvu is about deceit and dishonesty or mistakes and complications.
Did the Amherst addiction specialist really intend to cheat local insurers by charging patients for visits while he was out of the country?
And did he knowingly bilk them out of even more money by billing for individual sessions when the treatment was really group therapy?
Those questions are at the heart of a federal prosecution accusing Cheruvu of overbilling HealthNow, Independent Health and Univera by about $776,000 over a four-year period.
"This is not a mistake," Assistant U.S. Attorney Elizabeth R. Moellering told the jury hearing the case. "The evidence will show a pattern of deceit by Dr. Cheruvu."
Now in his 60s, Cheruvu has been treating opioid addicts and others since his own recovery several years ago and has a reputation as an "exceptional doctor," according to his lawyers.
"I know it's hard to believe the government got it wrong, but they did," defense lawyer Mark E. Schamel said at one point in his opening statement.
Cheruvu, who was investigated by the FBI and charged with health care fraud and submitting false statements relating to health care matters, is accused of submitting false and fraudulent claims seeking reimbursement.
Prosecutors said the false claims included bills for one-on-one counseling when patients were actually seen in a group therapy setting.
They also claim the doctor sought reimbursement for 2,325 office visits that took place while he was absent from the office.
"Dr. Cheruvu went out of town but Dr. Cheruvu didn't stop billing," Moellering said.
To make their case, prosecutors are expected to call several of Cheruvu's former patients, as well as law enforcement officials involved in the investigation.
The defense is expected to argue that the insurance reimbursement system is complicated and confusing, and that it was Cheruvu who first went to the insurers with questions about how to bill certain treatments.
The doctor may also call former patients as witnesses as part of a strategy that will suggest his reputation as a well-respected physician flies in the face of allegations that his true motivation was money.
"This trial is about mistakes," Schamel said. "This is about nuances. This is complicated."
Cheruvu also was charged with overbilling in a separate state court case that is still pending. His federal case is before U.S. District Judge William M. Skretny.