A psychiatrist who billed Medicare and private insurers for patients he never treated was sentenced Friday to 46 months in prison and ordered to pay more than $1.3 million in fines and restitution.

Richard Skodnek, 48, of Newton, was convicted in August of 136 charges, including fraud and obstruction of justice, by a federal jury that rejected his insanity defense.

Prosecutors said Skodnek routinely fabricated diagnoses including drug abuse and sex abuse— for patients he had never seen and billed insurers for sessions that never happened. Skodnek had claimed in court papers that he hears a voice, called "the announcer." His attorneys said he was suicidal.

US District Judge Nancy Gertner ordered Skodnek to pay $1 million in fines to the government and about $358,000 to the insurance companies he defrauded.

"I am deeply troubled by the fact that Dr. Skodnek made up records of family members that he did not see," Gertner said.

Skodnek, who was led away from the courtroom in handcuffs, will never be allowed to practice in the mental health field again and must get therapy as a condition of sentencing.

His lawyers said they planned to file an appeal.

Defense attorney Jim Brady said Gertner's sentence was "more than really necessary." The judge herself conceded that 46 months in prison may be too long, but said she needed to follow strict federal sentencing guidelines.

"The message to the psychiatric and medical community at large is: 'Don't do it because we'll be after you,'" said assistant US attorney Diane Freniere.

Gertner refused to release Skodnek pending an appeal, saying his attorneys did "too good a job . . . in convincing me he's disturbed."

Debby Harritt, whose children were falsely diagnosed with depressive psychosis by Skodnek, said four years in prison "would never be enough to make up for what he did."

Harritt's children, Lori, 23, and Scott, 18, never met Skodnek. Harritt, 45, of Natick, and her husband were patients of the psychiatrist.

The fabricated records are still on file with the family's insurance company, she said. Skodnek told the judge that he ended up hurting the very people he wanted to help.

"My life, which I tried to dedicate to healing, became contaminated by wrongful actions," he said before he was sentenced.