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/
