Saturday, December 5, 2015

Michigan Doctor Sentenced to Long Sentence For Unlawful Prescriptions and Health Care Fraud in Case Involving Illegal Patient Marketing

The criminal cases for physicians improperly prescribing pain medications continue. Pain management physicians and regular practitioners will realize that the facts in most of these cases are fairly outrageous and not typical. 

What I often see in my practice is that the physicians who engage in this activity are oblivious to the risks they are taking with the license and their liberty. Often, like in this case, marketing new patients is a flood gate to problems especially when outside marketing individuals are hired.

In this case, on  November 16, 2015, Dr. Hussein Awada, 46, a physician who practiced in Warren, Michigan, was sentenced to 84 months in prison  for writing prescriptions for oxycodone and other controlled medications without medical justification, and for health care fraud. He was sentenced by U.S. District Judge Nancy Edmunds.

What happened in this case to cause such a long sentence?

1. Marketing. From 2010 through early 2012, the doctor worked with a marketer, James Lyons. One of the serious issues with marketers is that they are incentivized to bring patients whether there is medical necessity or not. The marketers will often coach the patients In addition, marketers are often paying patients or engaged in other misconduct. In this case, the marketers then bought the pills from the “patients” and re-sold them to street dealers.

2.  Lack of medical necessity for marketed patients. The allegation is that the patients brought in from marketing were coached and did not have medical conditions requiring the prescriptions for controlled medications and resulting in the billing to insurance companies and Medicare. Then the doctor allegedly wrote prescriptions for 80,000 oxycodone and Roxicodone, plus other controlled medications. 

3.  Health care fraud due to billing where no medical necessity. It was alleged that the doctor caused these same patients to receive monthly x-rays, and other invasive tests, which were medically unnecessary but helped to demonstrate purported need for the controlled substances and conceal his fraud. The doctor admitted in his plea agreement that he defrauded Medicare, Medicaid, and Blue Cross of about $2.3 million.

In addition to imprisonment, Dr. Awada was ordered to pay restitution to Blue Cross and Medicare in the total amount of $2.3 million, and was ordered to forfeit various assets and agree to pay the government $2.3 million.

4. War against prescription drug abuse. This case is part of the government's effort to prevent people from getting addicted to prescriptions drugs address the fact that more people die from overdoses of prescription drugs in America than from overdoses of all other drugs combined. The Prosecutor was quoted as saying "We hope that prosecuting the doctors who are putting these drugs on the streets will deter others from contributing to this epidemic.”

Attorney Commentary on Marketing Dangers:  While most physicians will not find themselves in this situation, even hardworking, conscientious doctors need to be careful of patients who come in from marketing since there is a much greater likelihood that the patients are benefiting in some way or are selling drugs back to the marketers or to pharmacies.

In Los Angeles, there have been elderly Medicare patients who get approached to report symptoms and obtain non-controlled substance drugs which then get sold to intermediaries who put them on the grey market. This is more common with expensive medications. Marketing creates problems when the individuals paid to bring recruit patients to practices seek methods of making revenue.


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.