Monday, February 1, 2010

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 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:


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.