California Pharmacist Charged With Filling Fraudulent Prescriptions for Oxycodone and Hydrocodone.

The opioid prescription cases keep coming. On April 11, 2019, a Fresno pharmacist, Ifeanyi Vincent Ntukogu of New Life Pharmacy, in Madera was indicted one count of conspiracy to distribute and possess with intent to distribute controlled substances and 17 counts of distribution of controlled substances (oxycodone and hydrocodone). The charges are only allegations; the defendants are presumed innocent until and unless proven guilty beyond a reasonable doubt.

Two other non-medical persons to whom the medications were allegedly dispensed were also charged: Kelo White was charged with one count of conspiracy to distribute and possess with intent to distribute controlled substances and 12 counts of possession with intent to distribute controlled substances. Donald Ray Pierre was charged with one count of conspiracy to distribute controlled substances, 10 counts of possession with intent to distribute controlled substances, and two counts of identity theft. 

According to court documents, Mr. Ntukogu allegedly filled fraudulent prescriptions for oxycodone and hydrocodone, Schedule II controlled substances, at his pharmacy New Life Pharmacy between December 2014 and November 2018, and then dispensed the controlled substances to Mr. White and Mr. Pierre. 

Internal Medicine Physician Convicted in Los Angeles Federal Court After Six-Day Trial of Conspiracy to Pay or Receive Kickbacks for Medicare Referrals and Four Counts of Receiving Kickbacks.

Health care fraud and kickback cases can be difficult to defend due to the amount of documentation and when there are numerous cooperating witnesses. A recent case, seemed to have a number of weak, inconsistent witnesses who had already plead guilty and were caught in direct mistruths and changing stories. However, the jury nevertheless convicted the doctor defendant.

On August 23, 2018, after a six-day trial, a federal jury convicted Dr. Kanagasabai Kanakeswaran an internal medicine doctor with a practice located in Lancaster, California of one count of conspiracy to pay and/or receive kickbacks for Medicare referrals and four counts of receiving kickbacks for Medicare referrals.

The government contended that the evidence presented at trial showed that from 2008 to 2016, Dr. Kanakeswaran and others engaged in a conspiracy to refer Medicare patients to Star Home Health Resources (Star), a home health agency located in La Verne, in exchange for illegal kickback payments. The government alleged that Dr. Kanakeswaran received kickback payments in cash, as well as through checks payable to a company Kanakeswaran owned, Digital Perfection Corporation.The defense denied that there were any payments for referrals. 

The witnesses against the doctor who owned or operated Star or worked as marketers had all plead in a separate criminal case and were shown to have misrepresented numerous facts and were caught in a number of lies. The defense moved to dismiss the case based on prosecutorial misconduct and under Rule 29 but these motions were not successful. 

Two Northern California Doctors Face Sentencing in April 2018 After Being Convicted by Jury of Health Care Fraud After 8 Week Trial for Billing for Unperformed Services, Unseen Patients and Other False Billing Statements

Years ago, health care fraud cases would only be brought in extreme cases for ghost billing or outrageous conduct. We are seeing cases involving upcoding the office visit, not adding a physician to the group or not dropping the physician to the group, and for exaggerating conditions. A recent case seems to fit in that profile.  

Two physicians who went to trial and were convicted of some counts are awaiting sentencing. Dr. Vilasini Ganesh, a family practice physician and head of Campbell Medical Group, was convicted of 10 health care fraud and false statements relating to health care matters and Dr. Gregory Belcher (an orthopedic surgeon) was convicted of one count of making false statements relating to health care matters. Both were acquitted of some counts. There was an 8 week trial before the Honorable Lucy H. Koh, U.S. District Court Judge, and sentencing is now set for April 4, 2018 before the same judge.

The government contended that the evidence at trial showed that from 2009 to 2014, Dr. Ganesh submitted false and fraudulent claims to several health care benefit programs for services that she knew were not properly payable, by including claims for days when the patient had not been seen by the provider, exaggerated the amount of time spent with the patient, and submitting claims showing patients were seen by another physician provider who was no longer affiliated with her practice. There was alleged billing when the office was closed or the doctors or staff were out of state.  The government also contended that Dr. Belcher had on at least one occasion submitted a false claim in connection with a billing matter related to his physical therapy practice.  

This case moved relatively quickly since it was in July 2017 that the doctors were indicted by a federal grand jury charging them with one count of conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349; one count of conspiracy to commit money laundering, in violation of 18 U.S.C. § 1956(h); and multiple counts health care fraud, in violation of 18 U.S.C. § 1347, and 2 and false statement relating to health care matters, in violation of 18 U.S.C. § 1035.   

The maximum sentence is not indicative of what the sentence will be but it still frightens any physician or individual faced with these charges. The maximum statutory penalty for each count in violation of 18 U.S.C. Section 1347 is 10 years imprisonment and a $250,000 fine plus restitution, if appropriate.  The maximum statutory penalty for each count in violation of 18 U.S.C. Section 1035 is five years imprisonment and a $250,000 fine plus restitution, if appropriate.  However, any sentence will be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553. 

I would assume that there may be motions for a new trial, possible appeals and potential resolutions given that the acquittals on the money laundering counts and some of the other counts.

Posted by Tracy Green, Esq.
Green and Associates  

Grand Jury Indicts Los Angeles Doctor Who Headed Liver Transplant Program on Charges of Allegedly Covering Up Patient Switch With Falsified Records

On January 6, 2009, Dr. Richard R. Lopez Jr., a Los Angeles surgeon who was the director of the liver transplant program at St. Vincent Medical Center in Los Angeles was indicted by a federal grand jury for lying to the national organ transplant network after a liver accepted on behalf of one patient was instead transplanted into another patient who was significantly lower on the national wait list.

The eight-count indictment accuses Dr. Lopez of conspiracy, one counts of concealment of a material fact, and six counts of falsification of records in a matter under the jurisdiction of the United States Department of Health and Human Services. Dr. Lopez is scheduled to make his initial appearance on January 25. An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty.

According to the indictment, in September 2003, St. Vincent was offered a liver for a St. Vincent patient, identified as A-H, who ranked second on the match list for that liver, but who was in his home country of Saudi Arabia. The backup patient for the liver was at another local hospital. Instead of advising the organ procurement organization of the intended switch and allowing the organ to be offered to the backup patient, Dr. Lopez approved acceptance of the liver and its transplantation into a patient at St. Vincent—a patient identified in the indictment as A-B, who was ranked 52nd on the match list behind nine other St. Vincent patients.

After A-B received the liver, Dr. Lopez and his co-conspirators are accused of falsely telling authorities at the national organ transplant network that A-H had received the liver, and later submitted a falsified pathology report on A-H’s “explanted” (removed) liver. As a result of the false reporting, A-H was removed from the liver transplant wait list in September 2003, and was thereafter deprived of the opportunity to have this life-saving operation, according the indictment.

However, it is alleged that Dr. Lopez continued to tell A-H that he was on the liver transplant wait list and instructed A-H return to the United States in April 2004, when A-H was found to be too ill to be transplanted. He subsequently returned to Saudi Arabia, where he later died.

The indictment alleges that in reports filed until 2005 with the authorities operating the national organ transplant network, Dr. Lopez and unnamed co-conspirators continued to maintain the fiction that A-H had received the liver transplant. In 2005, the switch and cover-up were discovered by senior management at St. Vincent, and the matter was reported to authorities.

Dr. Lopez has not been associated with St. Vincent since late 2005. The hospital has fully cooperated with federal authorities since the beginning of the investigation.

Seven of the eight counts in the indictment relate to the false reporting of the recipient of the liver offered for A-H. The last count relates to another incident in which a liver was switched to a different recipient and, following the transplant, Dr. Lopez allegedly misrepresented the circumstances of the switch.

If convicted of the eight counts in the indictment, Lopez faces a statutory maximum penalty of 130 years in federal prison. The case was investigated by agents from the Department of Health and Human Services, Office of Inspector General and the Federal Bureau of Investigation.

Attorney Commentary: This case is reflective of two important factors: (1) it was the falsification of records that created the criminal problems and (2) the world-wide shortage of organs. The organ shortage is going to get worse before it gets better.

The Jan. 9, 2010 Wall Street Journal has an interesting and educating article on this issue entitled "The Meat Market." According to experts in this field, there are options. To increase the supply of transplant organs, it would be helpful to have presumed consent, financial compensation for living and deceased donors and point systems. Many people have died but there is a push for innovation in organ donation that will save lives.

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. Their website is: http://www.greenassoc.com/