Tuesday, November 14, 2017

Non-Physician Operator of Medical Clinic in Burbank Sentenced to 37 Months for Federal Healthcare Fraud in U.S. Central District

Years ago, healthcare fraud would be prosecuted primarily if there were "ghost" billing (billing for non-existent patients or services that were never provided). That has changed significantly and billing for patients who were brought in by marketers for allegedly "medically unnecessary" services has become more common. A recent case shows how these cases are being aggressively handled at the federal level in Los Angeles.

On October 2, 2017, Knarik Vardumyan, a non-physician "owner-operator" of a Burbank medical clinic was sentenced to 37 months in federal prison on federal healthcare fraud charges for participating in a scheme to defraud Medicare by prescribing unnecessary services and equipment, which allegedly often were not even provided. The sentence was imposed by United States District Judge Dale S. Fischer. 

Judge Fischer also ordered Ms. Vardumyan to pay $1,711,789 in restitution to the Centers for Medicare & Medicaid Services. There was no trial in this case since Ms. Vardumyan pleaded guilty in April 2017 to two counts of federal healthcare fraud.

In the plea agreement, Ms. Vardumyan admitted that she knowingly and unlawfully participated in a scheme to defraud Medicare by billing Medicare for “medically unnecessary office visits and diagnostic tests,” and by arranging “for the issuance of . . . prescriptions and orders for medically unnecessary durable medical equipment” and “home health services.” This case involved billing for office visits, diagnostic tests, durable medical equipment and home health. This means that there must have been some coordination between the ancillary services and Ms. Vardumyan's clinic.

There was improper marketing since Ms. Vardumyan further admitted, “many, if not all” of the people who visited her clinic “were brought . . . by co-schemers known as ‘marketers,’ who offered promises of free, medically unnecessary [equipment] or food” to those Medicare beneficiaries who were willing to attend Vardumyan’s clinic.

Although there was a plea, the government suggested a 37 month sentence which Judge Fischer apparently agreed with in addition to the sentence suggested by Pretrial Services. The sentence suggests to me that Ms. Vardumyan was not able to repay much restitution prior to sentencing.

This was was investigated by the Federal Bureau of Investigation which has a strong healthcare fraud unit.

Posted by Tracy Green, Esq.

Sunday, July 16, 2017

Southern California Physician Indicted For Illegally Prescribing Controlled Drugs Including to Out-of-State Residents Without an In-Person Physical Examination

The investigations of physicians for prescribing scheduled drugs to patients including Oxycodone, Xanax, Soma and other medications continues. Last week on July 6, 2017, a physician Jeffrey Olsen D.O. was Indicted in the Central District of California, Case No. SA CR-17-76. Dr. Olsen is presumed innocent and an Indictment is not evidence. 

One issue I have with these criminal cases is that in order to "catch" the physicians, the DEA will wait for a year or more to get the "evidence" to support criminal cases. In Dr. Olsen's case, the charges date from 2013 to January 2016. While it is not clear here, most cases I see have the government investigators sending in undercover agents and seeking to get evidence to support the criminal charges. In the meantime, allowing the physician to continue to prescribe. Public safety is being sacrificed to make sure the "criminal" case is as open and shut as possible. 

In Dr. Olsen's case, the DEA went in on or about March 18, 2016 and suspended his DEA registration. There was no arrest or charges at that point in time but I suspect that his charts were seized or reviewed by the DEA.

The Indictment alleges that Dr. Olsen allegedly sold prescriptions to addicts and drug dealers in exchange for fixed cash fees, without any medical basis for the prescriptions. It is also alleged that during the investigation, Dr. Olsen also sold hundreds of prescriptions to addicts in other states, such as Oregon, without ever seeing the “patients” for an in-person examination. 

It is alleged that in text messages to these out-of-state customers, Dr. Olsen allegedly told customers that, in exchange for fees up to $3,000, he would write prescriptions for them. It is alleged that Dr. Olsen let the patients select the medications and that he failed to follow the standard of practice and determine whether they were actually taking the prescribed drugs or whether they were getting additional narcotic prescriptions from other doctors. 

It is alleged that Dr. Olsen's prescriptions resulted in more than 1.2 million pills of narcotics, which were almost entirely at maximum strength, in addition to hundreds of thousands of pills of other controlled drugs such as the sedatives Xanax and Soma. Dr. Olsen was charged with 34 counts of drug related charges under 21 U.S. Code Section 841(a)(1) for "distributing" oxycodone, amphetamine salts, alparzolam and hydrocodone to various patients who are listed by initials in the Indictment. 

One questions why the Medical Board is not used to get an immediate administrative suspensions along with DEA when there is significant evidence of improper prescribing. Is it wise for the government to wait one or two years to "investigate" and build criminal cases just to make sure they can get high sentences against physicians? 

The final count was for a violation of 21 US Code Section 843(a)(4)(A) for making an alleged False Statement in a DEA Registration Application. This relates to Dr. Olsen applying for DEA registration on or about May 23, 2016 and failing to disclose his DEA suspension on March 18, 2016. It is critical for physicians to ensure they do not make any misrepresentations in filling out these forms.

It is not clear if the government offered Dr. Olsen the opportunity to plea or cooperate before Indictment. However, these charges are heavy handed and could expose Dr. Olsen to 20 years' in custody and a mandatory minimum term. I still wonder what would have happened if the conduct had been stopped back in 2013 or 2014.

Posted by Tracy Green, Esq.
Green and Associates
Office: 213-233-2260

Saturday, July 15, 2017

Indictment Filed Against Northern California Physician For 36 Counts of Unlawfully Distributing Oxycodone by Prescribing It "Outside the Course of Usual Professional Practice"

When it comes to prosecuting physicians for unlawful prescribing of opioids or scheduled drugs, federal authorities have more stringent laws and sentencing guidelines. Recently a physician was arrested last year by the San Francisco District Attorney's Office and charges were not filed. However, just more than six months later federal charges were filed against the same physician. 

On or about July 11, 2017, Christopher Owens, a physician licensed to practice in California, was indicted on charges relating to unlawfully prescribing oxycodone. Dr. Owens now lives in Indiana but previously practiced at UCSF. Dr. Owens is presumed innocent and charges in an Indictment are not evidence. The DEA is one of the investigating agencies and can also proceed administratively against the physician.

The Indictment alleges that over a three-year period between September of 2012 and June of 2015, Dr. Owens intended to act outside the course of usual professional practice and without a legitimate medical purpose when he prescribed oxycodone on numerous occasions.  In sum, Owens is charged with 36 counts of distributing oxycodone, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C). Each count of oxycodone prescription can carry a separate long sentence.

Dr. Owens was arrested on Tuesday, July 11, 2017, in Indianapolis, Indiana, and was to appear in Indiana before a U.S. Magistrate Judge for a detention hearing on Monday, July 17th. He will then be ordered to appear in San Francisco federal court.

Dr. Owens was a well known vascular surgeon who had privileges at UCSF. He was placed on administrative leave back in June 2016 according to UCSF just a few days after his girlfriend passed away due to a drug related overdose. Later, UCSF reported that they revoked his privileges in October 2016. 

Then in early November 2016, the San Francisco DA's Office filed 99 counts for distributing, prescribing or giving away controlled substances against Dr. Owens. The charges were dismissed and it seems there was a decision to allow the federal authorities to pursue the case.  

These federal charges for prescribing or distributing oxycodone can be very serious with sentences up to 20 years and a mandatory minimum 10 year sentence. The mandatory minimum sentence can be negotiated with a plea agreement but when the government picks and chooses the prescription counts, these cases can be difficult to defend unless there was legitimate medical need for the prescription. It is usually a battle of the experts and a microscope is taken to the medical records and the patients' prior medical history.

In addition to the criminal case, the physician will also face the DEA and the Medical Boards of each state in which he is licensed. There can also be potential malpractice cases although each of the prescriptions are more than two years old. Publicity can bring out malpractice cases. Collateral consequences of this type of case is often as punishing as the potential prison time and fines. 

Posted by Tracy Green, Esq. 
Green and Associates, Attorneys at Law
Email: tgreen@greenassoc.com
Office: 213-233-2260

Wednesday, July 12, 2017

CVS Pharmacy Inc. Pays $5 Million to Settle Alleged Violations of the Controlled Substance Act in Sacramento Federal Case

As is the norm, national chain pharmacies get fines and compliance plans while small businesses get criminally prosecuted. A recent settlement between the Department of Justice and Drug Enforcement Administration (DEA) with a national chain pharmacy is no different.

On or about July 5, 2017, CVS Pharmacy Inc. agreed to pay $5 million to resolve federal Controlled Substances Act (CSA) allegations that its pharmacies in the Eastern District of California failed to keep and maintain accurate records of Schedule II, III, IV, and V controlled substances. This payment covered only one federal court district. 

CVS also agreed to an administrative compliance plan with the DEA. The payment and plan resolve the United States’ allegations that during the period from April 30, 2011, through April 30, 2013, CVS pharmacies failed to provide effective controls and procedures to guard against diversion when CVS allegedly failed to:
(1) record the amount received and the date received of Schedule II drugs on DEA-222 Forms;
(2) maintain DEA-222 Forms and keep them separate from other records;
(3) record the date of acquisition of controlled substances in Schedules II through V; and
(4) maintain invoices for drugs in Schedules III through V and keep the records separate from non-controlled substance records; and conduct a biennial inventory on one specific day.

Under the settlement reached July 5, 2017, CVS acknowledged that its DEA-registered pharmacies were and are required to comply with the CSA, and that nine CVS pharmacies in the Eastern District of California failed to fulfill these recordkeeping obligations in a manner fully consistent with CVS’s responsibilities under the CSA. The settlement and compliance plan cover the 168 CVS pharmacies that operated in the Eastern District of California from April 30, 2011, through April 30, 2013.
The allegations resolved by this settlement were uncovered during a DEA investigation that began in 2012 after CVS self-reported thefts and losses of hydrocodone, a Schedule III drug at the time, at five of its Sacramento-area pharmacies. Under the CSA, DEA-registered pharmacies are obligated to report any thefts or significant losses of controlled substances to DEA.

On the compliance side, to address the issues uncovered by this investigation, CVS made improvements to its pharmacies in the Eastern District of California by, among other things, instituting annual CSA compliance training of its pharmacy staff, increasing loss prevention oversight, and excluding controlled substances prescriptions from the volume metric that can impact pharmacy staff compensation.

All non-chain pharmacies can learn from this compliance plan and how record keeping issues can result in large fines. It's especially critical for non-chains since they can get their DEA pulled and even criminal prosecution.

Posted by Tracy Green, Esq.
Email: tgreen@greenassoc.com
Office: 213-233-2260

Friday, July 7, 2017

Los Angeles Dentist Charged With Fraud for Allegedly Billing Insurance Carriers for Services Not Provided Over 7 Year Period

We have seen an increase in audits of dentists by private insurers. Big data and updated computer systems have made it easier for insurance carriers to flag suspicious billings. 

If intentional billing for services not provided is found, it can be referred for criminal prosecution and/or to the Dental Board. This is one reason to handle audits very carefully and to address any billing errors or other issues in a way that does not create additional problems.

A Los Angeles dentist, Carlos Maria Vallarta Fausto, self-surrendered on a case filed by Los Angeles District Attorney's Office after he was charged with two felony counts of insurance fraud for allegedly charging insurers more than $31,000 in billings for services not performed on patients in his Los Angeles area dental practice between January 1, 2007 and December 31, 2014. Dr. Fausto is presumed innocent and a felony complaint is not evidence. The bail on this case was set at $25,000 and he was released immediately.

After an audit, an insurer filed a complaint against him with the California Department of Insurance which launched its own investigation, which allegedly revealed Dr. Fausto billed multiple insurance companies for dental treatment he did not render to his patients over this seven-year period. The case has also been referred 
 to the Dental Board of California, which is responsible for licensing dentists in California.

Attorney Commentary: There are several things to note from this case. First, even with a loss amount of $31,000 over a seven-year period, the case was referred criminally. Years ago, low loss amounts were not filed. Prosecutors are getting more aggressive about smaller cases especially where they believe there is "ghost" billing or billing for services not provided.

Second, these allegations are from years ago but the statute of limitation continues to run where the alleged fraud is not discovered.  Thus, even though some of the services were 10 years old (2007), charges were just filed. It takes years for these cases to be investigated and the alleged misconduct stopped in 2014.  The state statute of limitation is 4 years from date of discovery.  

Third, it should be remembered that even if the criminal case is dismissed or won, the dentist will still need to address the Dental Board which has a lower burden of proof and usually waits until the criminal case is concluded. The Dental Board can be very aggressive and the dental license is the tail that wags the dog in this type of case.

Finally, periodic self-audits, compliance and making sure that insurance billing is accurate is good business. When you bill insurance companies or the government, you need to be extra careful. The old saying of it's better to ask forgiveness than permission doesn't work in government or insurance billing.  

Even a $30,000 billing issue over seven years does not always just go away by paying the funds back in today's world.  I have seen cases where repayment upon discovery of erroneous billing helped avoid criminal and Dental Board referrals but these cases need to be handled carefully and with a view of the big picture at 40,000 feet.

Posted by Tracy Green, Esq.
Office: 213-233-2260

Wednesday, May 24, 2017

The Fifth. Why Michael Flynn's Lawyer Properly Advised Him to Exercise His 5th Amendment Rights in Response to Congressional Subpoena.

No one should be in favor of overzealous prosecutions. We should also let all people exercise their constitutional rights. Even when we disagree with their politics or actions. The case of Ret. Lt. Gen. Flynn is no different. If anything, we need to be even more careful since this is a high profile case and is related to one of the most important criminal investigations in recent U.S. history. 

If I were Michael Flynn's lawyer and he were subpoenaed to Congress, what would I do? Have him do exactly what was done by his lawyer - exercise his 5th Amendment right against self-incrimination. Doing anything else would be legal malpractice in my view unless there were a solid immunity agreement. Even the request for documents is a problem since there are testimonial issues in identifying and producing documents that relate to his 5th Amendment rights.  

First, don't let a client testify or be interviewed when there's a criminal investigation. Simple. Don't care if he looks guilty. Gotta do it. If you don't it's malpractice or folly. You cannot care about the "optics" or that "someone will look guilty." Clients have a hard time understanding it but it is critical to not give into that type of thinking. I would lay down in the street outside my office in downtown Los Angeles before I'd let a client testify under these circumstances.

I would have Mr. Flynn exercise his 5th Amendment rights for numerous reasons. Let us just use his public FARA filings as one basis since we can review them.  To look at the issue, just take a look at the Mr. Flynn's Supplemental Foreign Agent Registration Act (FARA) filings on 3/7/17. They were signed by him electronically under penalty of perjury. Read them if you like [here's the FARA document search link], type in Flynn, click and see what you think. 


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