Doctor & Acupuncturist Sentenced In Manhattan Federal Court For Operating Medical Clinic That Billed Under New York's "No Fault" Accident Law

On January 31, 2010, in Manhattan Federal Court, United States District Judge Lewis A. Kaplan sentenced Romilla Anwar (a physician) to 30 months in prison and Anatoly Sunik (an acupuncturist) to 12 months in prison on health care fraud charges relating to treatments relating to injuries sustained in automobile accidents billed under New York's "no fault" law.

This sentence came after the men each pleaded guilty in April of 2009, stemming from their alleged operation of the Avenue K Medical Clinic in Brooklyn, New York (the "Clinic"). The Avenue K Clinic was alleged to be primarily engaged in the treatment of individuals who filed no-fault insurance claims with insurance claims. Under New York state law, no-fault insurance enables the driver and passengers of a vehicle registered and insured in New York to obtain benefits of up to $50,000 per person or injuries sustained in an automobile accident, regardless of fault.

The arrests in this case were originally in July 2008 when 12 people were arrested. According to the Criminal complaint, Indictment, guilty pleas and court filings from May 2006 to June 2008, the Clinic routinely billed automobile insurance companies under the no-fault program for medical "treatments" which were either never provided or unnecessary, because the person being "treated" did not medically need the treatments.

In the first two years of its operation, the Clinic allegedly billed insurance companies a total of approximately $3.6 million for no-fault medical services on behalf of more than 500 patients and, as of June 2008, had received approximately $1.2 million from these insurance companies.

Dr. Anwar served as the Clinic's nominal owner and treating physician, and, in that role, she allegedly performed perfunctory examinations of patients and recommended treatments she knew to be unnecessary. At her guilty plea, Dr. Anwar stated: "On many occasions individuals were prescribed DME [Durable Medical Equipment] which were unnecessary because the individuals were either slightly injured or not injured at all. I also ordered MRIs which were unnecessary due to the fact that the individuals were either slightly injured or not injured at all."

Mr. Sunik, the acupuncturist, allegedly billed insurance companies for 30 minutes of acupuncture even though he often provided only a few minutes of treatment. A physical therapist was also charged in the original Indictment.

One of the Clinic's owners was already sentenced: Sviatoslav Jadan (30 months in prison). Another owner Samuel Vilshanetski is scheduled to be sentenced on March 19, 2010. It was alleged that the owners of the Avenue K Clinic engaged "runners" (who were three of the initially charged defendants) to recruit patients for the Clinic for treatment. The owners allegedly paid the runners an average of approximately $2,000 per patient but paid them only after the referred patients had received enough treatments for hte patient to be profitable.

There were law firm links a well since it was alleged that runners made more money when a patient was accepted as a law office client because certain law offices paid fees to the Clinic for each patient signed up as a client.

In cash kickback cases, one issue that arises is how was the cash obtained? In this case, it was alleged that there were various means. For example, money was allegedly laundered through one other defendant who owned medical transportation companies. The Clinic allegedly wrote checks to this defendants' medical transportation companies for sham invoices. This means that no transportation was provided but that the transportation company operated like a check cashing company where 90% of the money was returned to the Clinic and kept 10% for a check cashing fee. This enabled the Clinic to claim the invoices as a deductible business expense since kickbacks are not deductible.

In both California and New York, state and federal prosecutors are increasing the prosecutions of attorneys and health care professionals in the personal injury/automobile accident field. I expect to see more cases filed this year.

Any questions or comments should be directed to Tracy Green, a very experienced health care fraud attorney, at tgreen@greenassoc.com. Tracy Green is a principal at Green & Associates in Los Angeles, California.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and attorneys in insurance and health care fraud related matters in California and in other states, including New York and Florida. Their website is: http://www.greenassoc.com/

L.A. County Slashes Doctors' Reimbursement Rate - L.A. Times Article

Here is a recent Los Angeles Times article regarding Los Angeles County Board of Supervisors' vote to reduce the amount that L.A. County reimburses fees for patients' first three days of care at private hospitals under the California Physician Services for Indigents Program from 29% to 18% effective July 1, 2010. This is a result of state funding cuts which flow downhill.

This Program is funded through surtax on cigarettes and tobacco products; and provides funding to hospitals, physicians and community clinics based on uncompensated care provided to individuals not eligible for Medical Services Initiative (Medi-Cal) or any other government-funded program.

This rate cut will adversely effect emergency room doctors and on-call specialists who treat poor, uninsured patients at private hospitals in Los Angeles County. It could also lead private hospitals to close emergency rooms and send more patients to crowded county hospitals:

L.A. County slashes doctors' reimbursement rate - latimes.com

Should you have any questions regarding your own situation or this post, you can email physician attorney Tracy Green at tgreen@greenassoc.com. Green & Associates is located in downtown Los Angeles, California and focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. The lawfirm website is: http://www.greenassoc.com/
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Physician And Non-Physician Sentenced In San Diego For Submitting False Bills To Private Insurance Companies For Alternative Cancer Treatments

A recent health care fraud case in San Diego relates to alternative cancer and health care treatments and billing of insurance carriers. I expect to see an increase in the prosecution of health care fraud cases relating to the billing of private insurance companies and not just Medicare and Medi-Cal (Medicaid).
On February 8, 2010, William R. Fry and Dr. Geronimo Rubio in Case No. 04cr1276, were sentenced in federal court in San Diego by the Honorable John A. Houston, United States District Court Judge, to serve 14 months and 12 months in custody, respectively, followed by three years of supervised release following their release from prison.
Mr. Fry and Dr. Rubio each pled guilty to health care fraud and federal income tax felonies in June 2007. Judge Houston also ordered that, for their health care fraud convictions, Mr. Fry and Dr. Rubio were to pay $63,237 in restitution to insurance providers. Mr. Fry was also ordered to pay the Internal Revenue Service (IRS) $314,159 in back taxes plus interest and penalties for tax years 1997 through 2003. Dr. Rubio was ordered to pay the IRS $356,311 in back taxes plus interest and penalties for tax years 1998 through 2003.
According to court records, Dr. Rubio and Mr. Fry jointly owned and controlled a business called “American Metabolic Institute,” in Bonita, California. The defendants operated a health care clinic called “Hospital San Martin,” in Tijuana, Mexico. The clinic, under the direction of Dr. Rubio, offered alternative medicines and treatments to patients, many of whom were diagnosed with cancer. In their pleas, the defendants admitted that they submitted false bills to American insurance companies and that each defendant substantially under-reported his true income on his individual federal income tax returns.
It appears that the American Metabolic Institute had numerous complaints regarding the cost of treatment from patients. There were many supporters of the alternative care but when alternative treatment do not "cure" cancer or other diseases, there will be complaints. Law enforcement can take a view that the alternative provider is preying upon desperate people with cancer. Alternative providers need to be very careful and create systems and protocols that document informed consents and the nature of the alternative treatment.
Alternative health care providers need to realize that their websites and publications will be scrutinized carefully. One bad result or unhappy patient can result in a complaint to a Medical Board or governmental agency. The website will be one of the first things an investigator reviews. For example, Dr. Rubio still has a website that has success stories of cancer going into remission with immunology treatment. These treatments are different than traditional oncology and the websites should also be reviewed by a health care attorney.
Now a brief comment about the tax fraud counts. For those who bill private insurance companies and the government, you will always be under scrutiny and subject to audit and review. This also means that if there are allegations of wrongdoing, your tax returns will also be under a microscrope. The threat of a tax fraud prosecution which is document based -- black and white, no issue of medical necessity -- can often be the hammer that forces a guilty plea. This is also something that as a licensed professional or health care provider you need to consider when operating your business. Part of your compliance with rules and regulations should include compliance with taxes (federal and state) since there is exposure there as well.
Should you have any questions regarding your own situation or this post, you can email physician attorney Tracy Green at tgreen@greenassoc.com. Green & Associates is located in downtown Los Angeles, California and focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing alternative health care providers. Ms. Green is a naturopathic doctor attorney and is a member of the Board of Directors of the California Naturopathic Doctors Association. The firm website is: http://www.greenassoc.com/

Dangerous Or Disciplined Caregivers Not In HRSA's Database - L.A. Times Article

For those hospitals who are screening the employees and contractors they are hiring in health care, here is a Los Angeles Times article as to how certain problem licensed people are not on the lists that hospitals and certain health care companies rely upon. This is not a public database.

The article can be found at:
Dangerous caregivers not on list - latimes.com

More than 20 years ago, Congress authorized Health Resources and Services Administration (HRSA) to create a national database allowing hospitals to check for disciplinary actions taken anywhere in the country against nurses, pharmacists, psychologists and other licensed health professionals. The database is woefully inadequate and incomplete.

This article is a reminder that this database, the OIG exclusion list and the Medi-Cal or Medicaid exclusion lists are just one tool for screening potential hires. Background checks, including a criminal background check, drug tests, reference checks and other methods are critical to avoid problem employees or contractors. If you make the mistake of hiring an excluded individual, for example, you could jeopardize all your billing related to that employee or contractor.

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Adult Day Healthcare May Snap For Some - L.A. Times Article

A Los Angeles Times article on February 11, 2010 regarding the proposed closure of adult day healthcare centers can be viewed here:

Lifeline of adult day healthcare may snap for some - latimes.com

Under the most recent cost-saving budget proposals, 327 adult day healthcare centers throughout California would be eliminated. Cuts could save the state $135 million in fiscal 2011, state projections show. This is short-term. There is no analysis of the long-term cost.

Advocates and center operators said care for many of the 37,000 low- income participants -- who suffer from diabetes, brain injuries, dementia and other chronic conditions -- would cost the state even more money if the centers close. More than 40% of participants would end up in nursing homes, said Lydia Missaelides, executive director of the California Assn. for Adult Day Services. Others would be hospitalized.

Lydia Missaelides and nearly 20 others testified at a recent state Senate budget committee hearing in Sacramento against the elimination of the centers, which could occur as early as March 1.

Medi-Cal pays the vast majority of a center's care costs, which run about $76 per person per day, Missaelides said. The average age of a participant is 78, but centers serve centenarians as well as people in their 20s. All centers have nurses, dietitians, social workers and occupational, speech and physical therapists. Eliminating adult day healthcare services would affect family members as well as participants, operators said.

Should you have any questions regarding your own situation or this post, you can email adult day healthcare attorney Tracy Green at tgreen@greenassoc.com. Green and Associates is located in downtown Los Angeles, California and focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings.

The firm has a specialty in representing licensed health care providers including adult day health care centers. Ms. Green spoke at the California Assn. for Adult Day Services (CAADS) Fall 2009 meeting and is an associate member of CAADS.

The lawfirm website is: http://www.greenassoc.com/

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Should Doctors Or Professionals Talk To Police? If So, When? L.A. Times' Article: Jackson's Doctor's Case May Hinge On His 3 Hour Police Interview

The Los Angeles Times article today regarding cardiologist Dr. Conrad Murray's criminal case highlights what happens when someone is interviewed by police before charges are filed. Here is a link to the article:

Michael Jackson's doctor's case may hinge on his police statement - latimes.com

Dr. Murray spoke to police last summer for 3 hours with his attorney present. The L.A. County prosecutor in this case is claiming that the involuntary manslaughter charge is based in part on what came out of Dr. Murray's mouth, i.e., that propofol is a very dangerous drug.

What can we learn from this?

Some criminal defense attorneys will say - aha! what a stupid mistake - I NEVER let my clients speak to the police -- with or without me.

That is an unsophisticated view since most experienced white collar defense attorneys know that the best way to win 100% of your cases is to persuade the police and prosecutors NOT to file charges against your clients. So any hard or fast rule either way is suspect.

Dr. Murray's current attorney is trying to use the 3 hour conversation to his advantage: Dr. Murray had nothing to hide.

My thought is that there is no one way. Each case is different. But the one rule I have is that before my client speaks to the police (ONLY in my presence) we will be 110% prepared since we will have to live with those statements for the next 3 years and we don't know which twists and turns an investigation can take place.

I do NOT want my client to build a case against himself. Thus, if I know that the police will file charges against my client no matter what we present in terms of documents and statements -- then there probably is little point in the interview unless there are other good reasons such as minimizing the charges filed or educating the prosecutors when I know our facts will not change.

The second rule is that no falsehoods can be uttered during that conversation. We need to show that my client tells the truth.

The third rule is that no mistaken facts can be uttered during that interview since those can be portrayed as falsehoods or "lies." Thus, if my client does not know, he says he does not know or can look at records and find out.

There are more rules but this is dangerous territory since much ground can be said in a 3 hour conversation. The lawyer and his client need to be in control of the interview to the extent possible. Once control is lost - that is a problem. The lawyer and client also need to know as many facts as possible before submitting to the interview.

A high profile death such as Michael Jackson's is one that police will not leave alone with a mere statement. I would have asked: what do your medical records for Michael Jackson look like? Are there problems? Will this also be a Medical Board case? Perhaps we should submit the facts you want to get across in a proffer letter on my letterhead rather than a freeflowing interview where you do not know what will be asked.

Typical words to my clients when we analyze to submit to an interview or not: Think big picture. Look ahead and down the road, past the curve where you cannot see. Hope for the best but prepare for the worst in making these decisions.

Lawyers can always Monday morning quarterback. Law is often more of an art than a science. Educated decisions, however, are important.

A felony complaint is only an accusation is not evidence of guilt. Dr. Murray is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.

Should you have any questions regarding your own situation or this post, you can email physician attorney Tracy Green at tgreen@greenassoc.com. Green & Associates is located in downtown Los Angeles, California and focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers. Their website is: http://www.greenassoc.com/

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Inspiring Role Model On Gender & Age - Justice Mildred Lillie: Nixon Talks to Atty. Gen. John Mitchell About Supreme Court Prospect Mildred Lillie

There are a number of women lawyer and judges who inspire me. Mildred Lillie, who passed away in 2002, was one of them. She was the longest serving jurist in California, taking the bench of the Los Angeles Municipal Court in 1947, when women judges and lawyers were scarce, and going on to serve 55 years as a bench officer, 44 of them as an appellate justice. I had the pleasure of hearing her speak in person and age had not dimmed her wit or enthusiasm for law and life.

Interestingly, at the time she spoke her age was more of an issue than her gender. She spoke of herself as "chronologically gifted" or old. However, she did not let her gender or age stand in her way. She just did it.

I thought of the former Justice Lillie, when I saw this link about Richard Nixon when he was considering appointing her to the Supreme Court. In 1971, only 300 judges out of 8,750 in the U.S. were women. Nixon's choice was rejected by the ABA, however, who said that although Mildred Lillie was the most qualified woman in the country -- she was deemed "unqualified." This meant that no woman jurist was qualified to be a U.S. Supreme Court justice. This let Nixon off the hook.

Here is a link that shows more about Nixon's personality than former Justice Lillie's:

Weekend Series on History: Nixon Talks to Atty. Gen. John Mitchell About Supreme Court Prospect Mildred Lillie

Posted by Tracy Green at tgreen@greenassoc.com.

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L.A. County D.A. to Charge Doctor in Michael Jackson Case - L.A. Times Article

Here is the link to a Los Angeles Times article regarding the decision to charge Conrad Murray, M.D., in Los Angeles County with involuntary manslaughter in connection with administering a combination of surgical anesthetic and sedatives blamed in Michael Jackson's death last summer. Settlement negotiations broke down last week. Dr. Murray is to be arraigned in the afternoon of February 8 at the Airport Court branch of Los Angeles County Superior Court.

DA to charge doctor in Michael Jackson case - latimes.com

Involuntary manslaughter is the least serious homicide charge available to prosecutors, its maximum punishment of four years in prison. The charge, which applies to an unlawful killing committed without malice or intent to kill, turns on Dr. Murray’s alleged criminal negligence in allegedly giving Jackson propofol for an unapproved purpose -- the treatment of insomnia -- and outside of the normal operating room setting.

A felony complaint is only an accusation is not evidence of guilt. Dr. Murray is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.

Should you have any questions regarding your own situation or this post, you can email physician attorney Tracy Green at tgreen@greenassoc.com. Green & Associates is located in downtown Los Angeles, California and focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers. Their website is: http://www.greenassoc.com/

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Husband & Wife Owners of Los Angeles-Area Medical Equipment Company Sentenced to Prison for Medicare Fraud

On February 1, 2010, two married owners and operators of CHH Medical Supply, a Los Angeles-area durable medical equipment (DME) company, were sentenced to prison today in connection with billing fraud relating to "power wheelchairs." This sentence came after they were convicted in a federal court jury trial in July 2009.

In Los Angeles, there are numerous current investigations relating to DME fraud and many more indictments and prosecutions are predicted.

Gevork Kartashyan and Eliza Shubaralyan, husband and wife, were each sentenced to serve two years in prison by U.S. District Judge Stephen V. Wilson of the Central District of California. In addition, Mr. Kartashyan and Ms. Shubaralyan were ordered to serve three years of supervised release following their prison terms and to pay $400,000 in restitution, jointly and severally.

At trial, Mr. Kartashyan was found guilty of conspiracy to commit health care fraud and health care fraud, and Ms. Shubaralyan was found guilty of health care fraud. At trial, evidence was presented showing that this couple, through their company CHH Medical Supply, billed Medicare $949,859 and were paid $597,750 as a result of the billing. There was evidence presented at trial that most of this the billing was for medically unnecessary power wheelchairs and wheelchair accessories. The power wheelchairs were delivered to the Medicare beneficiaries but that they were not needed and, in some cases, not requested.

There was a parade of witnesses at trial. First, elderly Medicare beneficiaries testified about how they were recruited into letting the DME company use their the scheme. According to testimony, the beneficiaries were taken to Los Angeles-area medical clinics, where they turned over their Medicare numbers and other personal identifying information. Some beneficiaries testified that they were promised vitamins, diabetic shoes and other items that they never received, in return for providing their beneficiary numbers.

There was other evidence presented at trial that these clinics were in the business of generating fraudulent power wheelchair prescriptions that could be sold to DME company owners -- who then billed Medicare for the wheelchairs. There was testimony presented that many of the beneficiaries did not know they were getting a power wheelchair until it was delivered by CHH Medical Supply. All of the beneficiaries who testified at trial said that they did not need or use the power wheelchairs.

In addition, five physicians testified at trial that they never authorized or approved the power wheelchair prescriptions written under their names. Three of these physicians testified that they never worked at the clinics listed on the phony prescription pads.

There was testimony at trial that Mr. Kartashyan regularly purchased power wheelchair prescriptions. The evidence also showed that after the power wheelchairs were delivered, Mr. Kartashyan generated phony forms stating that the beneficiaries’ homes were appropriate for the use of a power wheelchair, even though no home assessment was conducted.

Attorney Commentary: Some DME providers when prosecuted for health care fraud believed that since the wheel chairs or other DME (such as hospital beds or other equipment) were in fact delivered to the patients and there was a prescription -- there was a complete defense on the criminal fraud case. Every case is different but a prescription and delivery does not guarantee immunity or a defense verdict in these cases.

A full assessment is necessary to evaluate whether there are illegal kickbacks, medical necessity, and other facts that could be used to show fraud. This assessment should be done early in the case before or just after search warrants are executed or subpoenas are served.

Consultation with an experienced health care fraud attorney is important in evaluating whether there are viable defenses and whether investigation and expert witnesses should be employed at an early stage.

Any questions or comments should be directed to Tracy Green at tgreen@greenassoc.com. Tracy Green is a principal at Green & Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers including, but limited to, DME providers in regulatory and health care fraud related matters. Their website is: http://www.greenassoc.com/

California Medical Board Admits Allowing Doctor With Discipline History To Monitor Another - L.A. Times article

The L.A. Times' articles about the Medical Board never look at the real issues behind the Board but focus on the sensational. This seems to be much ado about nothing - but it does violate their internal guidelines.

California Medical Board admits allowing troubled doctor to monitor another - latimes.com

The reality is that the Board is getting so tough on physicians that a much higher percentage of them will have disciplinary problems in their career . . . Of course we want physicians with real problems disciplined as a matter of public safety but the trend I see is that discipline is used like a sledgehammer to kill or punish an ant. Real patient safety issues often get overlooked over paperwork and technical issues that are easier to prove.


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Doctor & Office Manager Charged With Health Care Fraud: Case Involves 2nd Office, Pre-Signed Prescription Pads & Billing For Services Not Provided

On January 20, 2010, a doctor and his office manager were arrested and charged with billing government health care insurance programs for physician services, including office visits and tests, that were not provided as billed. They are also charged with prescribing medicine without a legitimate medical purpose.

On January 12, 2010, a federal grand jury in Columbus indicted Dr. Charles C. Njoku and his office manager or clinical supervisor, Veronica Scott-Guiler. The indictment was unsealed at the time of the arrests. They appeared before a U.S. Magistrate Judge Terence P. Kemp who ordered them released on their own recognizance. A date will be set for an arraignment.

Dr. Njoku had offices in Columbus and Akron and billed public health care programs under his own name and People’s Family Medical Center. Ms. Scot-Guiler, who is not a licensed health care professional, supervised his Columbus office.

The indictment alleges that between 2005 and March, 2009, Dr. Njoku and Ms. Scott-Guiler billed the programs for office visits and tests that were not delivered as billed, including office visits billed to the program while Dr. Njoku was out of the country. The indictment also alleges that Dr. Njoku gave Ms. Scott-Guiler pre-signed prescription pads and allowed her to write and issue prescriptions to patients for narcotics and other medications while he was out of the country. Further, it was alleged that Dr. Njoku allowed Ms. Scott-Guiler to see patients at his office then claiming that he had seen the patients when he submitted bills to the programs.

The indictment charges each of them with 14 counts of making false statements in connection with payment for health care services. Each count is punishable by a maximum sentence of five years' imprisonment. The indictment also charges each defendant with one count of health care fraud, punishable by up to 10 years' imprisonment, and four counts of illegal distribution of controlled substances, punishable by up to 20 years' imprisonment. The indictment also charges Dr. Njoku with one count of distributing a controlled substance without the appropriate form as required by law. That is punishable by a maximum sentence of four years imprisonment.

An indictment is merely an accusation. Defendants have a constitutional right to be presumed innocent until and unless proven guilty in court.

Attorney Comments: This is a case where there are two offices in different cities and a non-professional is managing one of the offices. It is important for professionals to be careful of the supervision requirements of second offices. Having blank prescription pads and only medical assistants or nurses at the office will not suffice if there is an audit by the DEA or a government health program. In most cases, there should be a nurse practitioner or physician assistant on site if patients are being seen with specific written protocols.

The laws of each state are different and must be reviewed carefully as well as the rules of the specific program being billed. Having multiple offices is where many billing errors can occur. If you have more than one office, have a compliance plan and ensure that your office is following all the rules and regulations.

Posted by Tracy Green. Should you have any questions regarding your own situation or this post, you can email Tracy at tgreen@greenassoc.com. Green & Associates in Los Angeles, California focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and have handled hundreds of health care fraud cases. Their website is: http://www.greenassoc.com/