Medicare fraud cases involving chiropractors are not very common. The reason for this is that Medicare severely limits coverage for chiropractic services to manual manipulation of the spine to correct a condition known as “subluxation.” The diagnosis of subluxation must be diagnosed and documented either by X-ray or a physical examination that is detailed and documented before Medicare will reimburse. Medicare does not pay for maintenance therapy or for chiropractic treatments that are for maintenance or to promote health.
In Los Angeles, a chiropractor, Danny Paveh (also known as Houshang Pavehzadeh) of the Sylmar Physician Medical Group, was charged in May 2013 with federal health care fraud (18 USC 1347), aggravated identity theft (18 USC 1028(A)(1), and forfeiture allegations. Dr. Paveh is presumed innocent and the fact that an Indictment has been filed is not evidence. This case is pending in the U.S. District Court for the Central District before Judge Manuel L. Real. Mr. Paveh was released on $100,000 bond and a trial date is not yet set.
The allegations in this case are that from 2005 to 2012 – a very long billing period – Chiropractor Paveh billed Medicare more than $1.7 million for chiropractic treatments for subluxation that were never properly performed. The government alleges that the patients only received massages and other non-reimbursable treatments from Dr. Paveh and massage therapists who worked at his group. Essentially, the government alleges that these were “false claims” submitted to Medicare. It is also alleged that Dr. Paveh committed “aggravated identity theft” by taking the patients information and billing Medicare.
Attorney Commentary Regarding This Chiropractor Medicare Fraud Case
First, it appears that Dr. Paveh may have come to the government’s attention via an audit to be performed by OIG. According to the government, Dr. Paveh was the second-largest Medicare biller in California for chiropractic services – even though he was the only chiropractor in his group. The government also alleged that he was not in the United States when some of the services were performed.
Second, although clients can panic when faced with an audit, the government alleges that when OIG investigators tried to conduct an audit of Pavehzadeh’s claims, he falsely reported to the Los Angeles Police Department that he had been carjacked and that patient files requested by the auditors had been stolen from his car. This could be used as a sentencing enhancement and to show false statements to government officials in conducting an audit.
Third, I often see clients who assume because they have billed certain procedures for years that it means that Medicare must not have an issue with the billing or documentation. Unfortunately, Medicare is known as “good faith” billing and it reserves the right to go back and audit and seek an overpayment in an administrative context or to seek criminal charges as was done here. Thus, years of billing does not guarantee that the government will not take action. Health care has changed over the years and Medicare has become much more aggressive in health care fraud cases.
Fourth, this case was being investigated for some years. This means that there was significant time to meet with the federal prosecutors and see if the case could be settled pre-indictment. In some cases, we are able to have the prosecutors offer a “reverse proffer” so the client and Medicare fraud attorney can see what evidence the government has so the case can be realistically assessed.
Finally, forfeiture allegations were filed in this case which can often tie up a defendant's assets and make it more difficult to defend oneself or to support oneself pending a trial. In evaluating anyone's potential exposure, it should be assumed that forfeiture allegations will be filed in any federal health care fraud case.
In cases like this, obtaining representation long before Indictment – and ideally at the audit stage – make the most sense so the case does not grow and if there are adverse facts, they can be handled at the earliest stage. If there is exculpatory evidence and facts that show innocence and good faith billing, then those facts can be presented as well.
Posted by Tracy Green, Esq.