San Joaquin County Doctor Convicted of Prescribing Opioids Without Medical Necessity to Patients in Federal Court

The problem with physicians prescribing opioid drugs to patients where there is not a proper medical and prescription history taken, lack of a proper medical examination to confirm the legitimacy of patients' pain complaints, and failure to assess the risk of addiction issues continues. 

On November 19, 2021, Dr. Edmund Kemprud, age 78, was convicted in Sacramento  federal court of 14 counts of illegally prescribing opioids and other controlled substances to patients. As is common in these cases, undercover officers went to his office in order to obtain evidence that would substantiate the charges. Usually pain medication patients do not want to testify against their physicians so undercover operations are common. 

According to evidence presented at trial, Dr. Kemprud was a physician licensed to practice medicine in California and worked in several locations around the East Bay and Central Valley. One of the more inflamatory allegations was that one of the offices was in the back room of a nail salon and medi-spa in Tracy, California. 

Dr. Kemprud prescribed commonly abused prescription drugs, including Hydrocodone, Alprazolam, and Oxycodone. The government introduced evidence that certain prescriptions were outside the usual course of professional practice and not for legitimate medical purpose. 

The government introduced evidence at trial showing that Dr. Kemprud ignored "red flags" which are indications that his patients were addicts or that they were diverting the drugs during the undercover patient visits. Dr. Kemprud charged $79 a visit and the evidence was that he often spent less than five minutes with a patient and would see 30 patients in less than a day. In family practice, those numbers are not unusual for follow up visits but when prescriptions for serious pain medications are being written -- a more extensive visit is expected.

Four Indicted in California for Billing Compound Cream Prescriptions to TRICARE and Labor Union Health Plans

The government has been investigating pharmacies that dispense and bill compound creams for the past 5 years as well as the marketing companies that work with them. Much of the focus has been on billings to workers' compensation carriers or billing to TRICARE, military health insurance, and billing to union health plans.

On February 4, 2020, a 48-count grand jury indictment was unsealed naming four  defendants relating to an Orange County compound pharmacy, Professional Compounding Pharmacy (PCP), that allegedly submitted fraudulent bills to the military’s TRICARE health plan and a labor union health plan for medically unnecessary compound cream prescriptions in which there was alleged illegal marketing. An indictment is not evidence and all defendants are presumed innocent until and unless proven guilty beyond a reasonable doubt. 

The indictment – which contains charges of health care fraud, mail fraud, illegal kickbacks and money laundering – alleges that PCP, its marketers and a physician fraudulently generated prescriptions for custom-made compound cream medications. The indictment alleges that some bills charged as $15,000 per tube.

The indictment alleges that two “pain clinics” in Lawndale and National City recruited beneficiaries of TRICARE and the International Longshore and Warehouse Union’s (ILWU) Pacific Maritime Association Welfare Plan. 

Northern California Physician Indicted for Prescribing Opioids to Patients Without a Legitimate Medical Need

Physicians continue to face charges for prescribing opioids to patients without a legitimate medical purpose. This is one area where physicians and advanced practitioners must exercise extreme caution. A recent case shows that federal charges will be filed in these cases.

On December 5, 2019, a federal grand jury brought a 14-count indictment against  physician Dr. Edmund Kemprud of San Joaquin County, charging him with prescribing opioids to patients outside the usual course of professional practice and not for legitimate medical purpose. An indictment is not evidence and the physician is presumed innocent.

According to the indictment, Dr. Kemprud maintained a medical practice in the California cities of Dublin and Tracy. The indictment alleges that on 14 occasions between September 6, 2018 and March 13, 2019, Dr. Kemprud allegedly prescribed highly addictive, commonly abused prescription drugs, including Hydrocodone, Alprazolam, and Oxycodone – outside the usual course of professional practice and not for legitimate medical purpose. 

In these type of cases, the DEA or investigating agency usually uses undercover patients in order to establish the proof to file such charges. Dr. Kemprud pleaded not guilty at his arraignment.

Attorney Commentary: Physicians, Osteopaths and advanced practitioners should review the Medical Board's published pain guidelines. It's a 90 page guideline published in 2014, and is now considered to establish the standard of care in California. There are also links in the document on topics such as benzodiazapenes (Xanax/Alprazolam) at issue in this case and how to taper patients from them ("the Ashton manual"). There is free web-based training on prescribing opioids from the CDC that should be reviewed and where a provider can earn free continuing education credits.

Posted by Tracy Green, Esq.

Green and Associates

Los Angeles Orthopedic Surgeon Sentenced to 30 Months in Federal Prison for Receiving Kickbacks for Referring Surgeries to Pacific Hospital and Using Medical Hardware From Hospital-Related Entity

On November 22, 2019, an orthopedic surgeon specializing in spinal surgeries, Dr. Daniel Capen, was sentenced to 30 months in federal prison after he pleaded guilty. Dr. Capen pleaded guilty in August 2018 to conspiracy to commit honest services fraud and to soliciting and receiving kickbacks for health care referrals relating to Pacific Hospital and related entities. 

In his plea agreement, he agreed that he received at least $5 million in kickbacks for performing hundreds of spinal surgeries that were mostly for workers' compensation patients. 

U.S. District Judge Josephine Staton who sentenced Dr. Capen also ordered him to forfeit $5 million to the United States and pay a $500,000 fine. 

Dr. Capen is 70 years' old and the sentence appears to have taken into account his age and his acceptance of responsibility for the plea. One reason the sentence is 30 months is due to the total loss related to the kickbacks. When there is an illegal referral fee, the entire bill is considered a false or fraudulent claim. Given the cost of hospital bills for such surgeries, the plea agreement indicated that the illegal referral fees resulted resulted in more than $580 million in fraudulent bills being submitted, mostly to California’s worker compensation system.

This kickback arrangement centered on the now-closed Pacific Hospital in Long Beach, which specialized in surgeries, especially spinal and orthopedic procedures. Pacific Hospital’s owner, Michael Drobot who is serving a 5-year sentence for conspiracy and illegal kickbacks, paid kickbacks to doctors, chiropractors and marketers in return for the referral of thousands of patients to Pacific Hospital for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system.

New Civil Qui Tam Lawsuit Filed Against South Dakota Neurosurgeon and His Physician-Owned Distributorships (PODs) Alleging Kickbacks for Devices Used in Spinal Surgeries

2016 Senate Report on PODs

The issue of physician owned distributorships (PODs) is still an issue with orthopedic surgeons and neurosurgeons. The Justice Department is still filing qui tam actions and joining actions filed by whistleblowers. Physicians need to be very careful when forming their own device companies or distributorships. Since 2013, OIG has stated that PODs are "inherently suspect" under the federal anti-kickback statute.

Recently, on November 14, 2019, the United States filed a civil qui tam complaint against South Dakota neurosurgeon Wilson Asfora M.D. and his medical device companies Medical Designs LLC and Sicage LLC. The complaint alleges False Claims Act violations arising from the alleged payment of kickbacks to Dr. Asfora tied to the devices he used in spinal surgeries which were purchased from his own distributorships Medical Designs and Sicage.          

The Anti‑Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by Medicare, Medicaid, and other federal healthcare programs.  The government’s civil complaint alleges that Dr. Asfora, Medical Designs, and Sicage engaged in multiple kickback schemes designed to pay Dr. Asfora hundreds of thousands of dollars in exchange for Dr. Asfora using spinal devices distributed by Medical Designs and Sicage in his spine surgeries. 

The civil lawsuit also alleges that despite receiving numerous warnings that he was performing medically unnecessary procedures with the devices in which he had a financial interest, Dr. Asfora allegedly continued to perform such procedures while personally profiting from his use of devices sold by Medical Designs and Sicage. 

The case is captioned United States ex rel. Bechtold, et al. v. Asfora, et al., No. 4:16-cv-04115-LLP (D.S.D.).  The claims asserted against the defendants are allegations only, and there has been no determination of liability.

Director of California Cosmetic Surgery Center Who Fled Pending Trial Is Returned to U.S. to Face Federal Charges in Health Care Fraud Case For Billing Cosmetic Procedures to Insurance as "Medically Necessary"

Extraditions for health care fraud cases are more common now especially where the loss amounts are high. In a recent case, Linda Morrow, a Rancho Mirage woman married to a plastic surgeon, David Morrow, who had fled the United States after being named in a 31-count federal grand jury indictment in 2016, arrived in Southern California on July 1 after being deported by Israel, which had determined that she had entered that nation on a fraudulent Mexican passport. Ms. Morrow faces federal charges related to allegations that she fraudulently billed insurance companies $50 million for “medically necessary” cosmetic surgeries has been returned the United States after fleeing to Israel two years ago.

          

Ms. Morrow appeared in U.S. District Court in Santa Ana on July 2, 2019 and entered a not guilty plea to a separate grand jury indictment that charges her with contempt of court for fleeing while free on bond. During that hearing, she was ordered detained and a trial date in the contempt case was scheduled for August 27. She will make another court appearance later this month to discuss the status of the pending health care fraud case.

Ms. Morrow and her husband, David Morrow, were arrested in Israel on June 16. David Morrow, who pleaded guilty in 2016 in the health care fraud case and was sentenced in absentia to 20 years in federal prison, is pending extradition proceedings in Israel. David Morrow also faces contempt of court charges for fleeing while he was pending sentencing.

Orange County Psychiatrist Sentenced to More than Four Years in Federal Prison for Writing Illegal Opioid Prescriptions to Drug Dealer

On June 19, 2019, a psychiatrist who practiced at a Santa Ana clinic was sentenced to 57 months in federal prison for issuing prescriptions for controlled substances, such as oxycodone, hydrocodone, alprazolam and amphetamine salts, to a non-patient in exchange for cash, admitting in his plea agreement that the prescriptions were without a medical purpose and he knew the drugs would be diverted and sold on the street.

Dr. Robert Tinoco Perez was sentenced by Judge Andrew J. Guilford. Dr. Perez pleaded guilty on February 25, 2019 to one felony count of conspiracy to distribute controlled substances.

Dr. Perez admitted that he wrote prescriptions for “patients” he had never met or examined, including an undercover officer. Dr. Perez admitted that he created fictitious medical records for drug customers to provide justification for their prescriptions.

Kentucky Cardiologist Sentenced to 60 Months for Health Care Fraud and False Statements Relating to Implanting Medically Unnecessary Stents and Falsifying Degree of Stenosis in Medical Records

Credit: The Daily Independent

On May 2, 2019, well-known Kentucky cardiologist Dr. Richard E. Paulus was sentenced, by U.S. District Court Judge David L. Bunning, to serve 60 months in federal prison for health care fraud and false statements almost three years after his trial and an acquittal by the court that got reversed on appeal. 

In October 2016, a federal jury convicted Dr. Paulus of one count of health care fraud and ten counts of making false statements relating to health care matters, after hearing evidence that he exaggerated what he saw on patients' angiograms and then defrauded Medicare, Medicaid, and private insurers, by implanting medically unnecessary stents in his patients and falsifying the degree of stenosis in their medical records. The case was started by a complaint to the Board about the number of stent surgeries performed and their medical necessity.

After the trial, the district court granted Dr. Paulus’s motion for an acquittal.  The Sixth Circuit Court of Appeals later reversed that decision, on June 25, 2018, and reinstated Dr. Paulus’s conviction, resulting in his formal sentencing. This is very unusual that a district court grants the motion for acquittal and also unusual that the conviction was reversed on appeal.

California Psychologist and Doctor Charged with Fraudulent Workers’ Compensation Evaluations Where Psychologist Was Not Certified as a Qualified Medical Examiner and Doctor's Certification Had Lapsed

In billing for evaluations of workers' compensation patients, health care providers should be very careful to ensure that they do not misrepresent themselves as a certified  Qualified Medical Examiner (QME) on a medical legal evaluation or billing statement. 

In addition, it is important to ensure that the bills for medical legal expenses have been reviewed so that the criteria for medical-legal billing has been met. A recent case shows how a report by two provider who were not properly certified QMEs led to criminal insurance fraud charges. 

On May 7, 2019, psychologist Danita Stewart and Dr. Catalino Dureza were charged for allegedly submitting fraudulent insurance claims for Medical Legal Evaluations. They are presumed innocent and charges are not evidence.

Dr. Stewart, a licensed psychologist, allegedly submitted 36 fraudulent insurance claims between April 2015 and June 2015 to five different insurers for Medical Legal Evaluations for a total of $90,714. A Medical Legal Evaluation is conducted to evaluate an employee’s work-related injury and is governed by the California Labor Code. 

Even though Dr. Stewart was a licensed psychologist she was not certified as a Qualified Medical Examiner as required to conduct and bill for Medical Legal Evaluations. Dr. Stewart allegedly conducted these fraudulent evaluations at clinics in Fresno, Tulare, and Kern Counties. Dr. Stewart was charged with 36 felony counts of Penal Code Section 550(a)(1) [one for each report], and 1 felony count of Penal Code Section 550(a)(7).

Dr. Dureza, a licensed medical doctor, had obtained the proper certification to conduct and bill for Medical Legal Evaluations, but his certification lapsed. Dr. Dureza allegedly continued to conduct and bill for Medical Legal Evaluations, and once he was recertified he conducted and billed for unauthorized Medical Legal Evaluations. Between January 2014 and May 2015, Dr. Dureza allegedly submitted 17 fraudulent insurance claims for Medical Legal Evaluations conducted in Fresno County to five different insurers for a total of $16,292. This is not a large loss amount but shows that they will prosecute for amounts under $25,000. Dr. Dureza was charged with 17 felony counts of Insurance Code 1871.4(a)(1).

Whether or not someone is a QME is a public record so it appears the insurance carriers must claim that they paid these bills understanding that the providers were CMEs. I have seen cases where a biller has placed a QME, IME and AME near the providers' name, not realizing that there could be confusion on what type of report is being billed. The carriers have been aggressive about billings for these reports even though the providers could have billed for treatment without a QME certification.

Posted by Tracy Green, Esq.

Green and Associates, Attorneys at Law

Florida Gynecologist Who Treated Incontinence Sentenced to Federal Prison After Being Convicted at Trial of Health Care Fraud

Going to trial is a difficult choice for health care providers in paper fraud cases where there are numerous and obvious billing errors. The issue is usually whether the government can prove beyond a reasonable doubt that there was intent to defraud and not billing errors. A recent case shows what happened when a Florida physician went to trial, testified and lost at trial. Obviously, it was a very difficult decision for her and her family which included teenage children. The sentence was dispensed this week.

On April 21, 2019, Sheetal Kanar Kumar, M.D. of Stuart, Florida, was sentenced to a total of 24 months in prison, to be followed by 2 years of supervised release. This sentence came after a trial in February where a federal jury convicted her of committing 23 acts of health care fraud. She was acquitted of 6 counts of health care fraud. Dr. Kumar testified on her own behalf at trial. 

According to the court record, including evidence introduced at trial, Dr. Sheetal Kumar owned and operated the medical practice Advanced Healthcare for Women in Stuart, Florida.  Dr. Kumar was an obstetrician and gynecologist who treated incontinence.  Dr. Kumar testified at her trial and according to the press testified that she did not plan a fraud and if there were billing errors she should have been allowed to pay the amounts back before being indicted.  

From January 2014 until July 2017, the government alleged that Dr. Kumar submitted or caused the fraudulent submissions of claims to Medicare, Medicaid and private insurance companies.  The fraudulent claims sought money for specific health care benefits, items, and services that were not provided as billed.  As a result of such false and fraudulent claims, Medicare, Medicaid and private insurance companies, made payments in the approximate amount of $637,000.

Attorney Commentary: The problem with a felony case is that it is not just the conviction but the collateral consequences that will follow a professional for the next 5 to 10 years, long after any sentence is served. Whether it is loss of a professional license, exclusion from Medicare and Medicaid programs, loss of a DEA license, loss of insurance contracts, the list of effects goes on and on.  This is why anyone billing Medicare and Medicaid should have a compliance plan which will give a "safe harbor" and avoid the allegations of criminal fraud and keep the case in a civil and administrative place. 

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law

Sutter Health LLC, a Medicare Advantage Provider, Pays $30 Million To Settle Alleged Overpayment Based on Beneficiaries' Health Status Risk Scores

It is not just fee-for-service providers that have audits and civil qui tam cases. Managed healthcare is facing review as well. Even providers who are paid capitation fees should be mindful of the codes submitted to managed care. A recent case illustrates why. 

On April 12, 2019, Sutter Health LLC, a California-based healthcare services provider, and affiliated entities (Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter Medical Foundation) agreed to pay $30 million to resolve allegations that these affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans known as "risk scores," which allegedly resulted in the plans and providers being overpaid. Sutter Health is headquartered in Sacramento, California.  

   

Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed healthcare insurance plans called Medicare Advantage Plans (“MA Plans”) that are owned and operated by private Medicare Advantage Organizations (“MAOs”).  MA Plans are paid a capitated, or per-person, amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans. 

Federal Charges Can Come From Billing Private Health Insurance: San Francisco Acupuncturist Indicted On Health Care Fraud Charges For Alleged False Billing and Upcoding

We are seeing an increase in investigation of acupuncturists and chiropractors relating to billings to private insurance companies. The charges can result from upcoding, billing on the wrong dates, miscoding and other acts and omissions. There is a difference between fraud and billing errors. Criminal fraud cases require proof beyond a reasonable doubt of an intent to defraud.

Health care providers have often thought that if they are not billing Medicare or Medi-Cal, they will not be the subject of federal investigation. Now that private insurance is subsidized by the government for low income individuals, there is a significant push to investigate these cases. In addition, private insurance companies are submitting the cases for prosecution. One recent case shows what these cases can look like. It also show that coding matters and claim submissions if not accurate can lead to fraud allegations.

On March 7, 2019, a federal grand jury indicted San Francisco acupuncturist Haichao Huang, charging him with health care fraud and making false statements relating to health care matters.  An indictment is not evidence and Mr. Huang is presumed innocent. 

According to the indictment, the government alleges that from February 2013 through June 2018,  Mr. Huang, age 46, was a health care provider who offered acupuncture, physical therapy, massage, and other services at his office in San Francisco.  The indictment alleges that Mr. Huang submitted claims for reimbursement to his patients’ health insurance plans, claiming that he provided reimbursable services and treatments when, in fact, he knew that the billings were false and not properly reimbursable.  

The indictment gives three examples of the ways in which Huang allegedly submitted billings for reimbursement.  First, Mr. Huang allegedly submitted requests for reimbursement for acupuncture and other treatments when, in fact, the patient had received either much shorter periods of treatment or no treatment at all.  This could be an upcoding situation or what is called "ghost billing" (billing for service that was not provided).

Second, after a patient reached the limit of acupuncture sessions allowed by the relevant insurance plan, Mr. Huang allegedly billed the plan for other types of treatments and services that were not provided in order to continue receiving improper reimbursements.  

Attorney Tracy Green Quoted in Los Angeles Times' Article Regarding USC Gynecologist Under Investigation. Green Is Concerned About Physicians Failing to Perform Proper Gynecological Physicals and Rectal Exams Due to Concern Over Sexual Misconduct Allegations.

Attorney Tracy Green was quoted in an article by the Los Angeles Times published on May 30, 2018 entitled "LAPD begins sweeping criminal probe of former USC gynegologist while urging patients to come forward. This is the type of case that is growing due to the media attention which means the need for due process and the need for a full and complete investigation is even more necessary when a media storm is occurring. 

I pesonally have seen a huge change in how physicians do physical examinations the past ten (10) years. While I will not comment on whether I believe there was any misconduct (unprofessional, malpractice or even criminal), I will say that due to cases like this, physicians are AFRAID of putting their hands on patients.

I just had a women's well women exam and pap smear. The physician - Board Certified Internist and woman with a chaperone present with 10 years of experience and USC residency and medical school - did NOT insert her finger in me to see if there were any tumors or thickening or the usual. Nor did she do a breast exam on me. In addition, I had just had acute diverticulitis with bleeding from the colon (for which I was on Cipro) and she did NOT do a digital rectal. She did not even ask. Physicians are too afraid that someone will say it was for 'sexual gratification' and file a complaint.

I am very concerned about all of this. Physicians and care providers should not abuse their position. However, patients need to be educated that part of proper medical care is inserting a gloved finger in the vagina and is necessary and is part of a proper well women's exam and not just for sexual gratification. Hardly. Doctors can feel tumors, thickening of the tissues, pick up on bleeding, check the cervix, feel for endometriosis, and more (I'm not a physician and did not train as one.) 

Read this article from a well-respected Gynecological Medical Practice on what to expect during a gynecological exam. The article states: "After the Pap Smear test, your health care provider will remove the speculum and perform a bimanual exam to check the health of your ovaries and uterus. This portion of the exam involves inserting a gloved and lubricated finger in to the vagina with one hand. With the other hand, they will press down on your stomach. You will feel pressure and some light discomfort is possible, but again, always tell your gynecologist how you are feeling throughout the examination."


So yes, I was shocked last month when I had a pap smear and there was no finger inserted to check out my gynecological health even though the female internist had a chaperone. (The Gynecologist under investigation had a chaperone always but that did not seem to protect him so physicians are using his case as a reason to do substandard defensive medicine.)

Physicians are scared. Guess what, there are some weird doctors out there but the overwhelmingly vast majority are good competent doctors who get no sexual arousal from putting their finger in a mid-50s white woman lawyer (me). Am I going to complain about the doctor who did not do the job she should? No. Sadly, most of the physicians are doing the same but I am hoping to educate physicians and the administrators to please not give into the fear and educate patients.

Please, let's be smart on how we respond to allegations. Please find out the facts. Please understand the medicine. And let's not scare all the doctors from doing good medicine.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law

Why Are Older Physicians More At Risk for Criminal Prescribing Charges? Recent Case: Older Santa Rosa Doctor Indicted For Unlawfully Prescribing Fentanyl And Oxycodone

I often see older physicians caught up in criminal prescribing cases. Part of it may due to impairment and part of it may be due to trusting others including patients. Older physicians need to seriously question their conduct and business arrangements since failure to follow the standard of care can be criminal if it involves scheduled drugs. The standard of care for pain management has changed drastically the last 10 years and the record keeping requirements have also increased.  

A recent case illustrates this issue. On October 2, 2018, a federal grand jury indictment against Santa Rosa neurologist Thomas Keller, age 72, was unsealed charging him with distributing Schedule II and IV controlled substances outside the scope of his professional practice and without a legitimate medical need. Dr. Keller was also charged with two counts of health care fraud related to billing. An indictment merely alleges that crimes have been committed, and Dr. Keller, like all defendants, is presumed innocent until proven guilty beyond a reasonable doubt. 

According to the indictment filed September 27, 2018, and unsealed on October 2, 2018,  in June of 2017, Dr. Keller, 72, of Santa Rosa, was a licensed physician when he knowingly distributed Oxycodone to a person knowing that the distribution was outside the scope of his professional practice and not for a legitimate medical purpose.  

Former California Medical Doctor Sentenced To Over Three Years In Prison For Unlawfully Prescribing Oxycodone to a Patient. Judge Noted Doctor Did Not Run a Pill Mill But Feeding One Patient's "Habit" Is Enough.

Previously, only physicians who went far over the line and ran "pill mills" got targeted for prosecution. Times have changed. One recent case shows a prosecution for a prescription of opioids to a single patient over a couple of years who was an addict. That patient died and local police declined to file charges so federal charges were brought on the prescribing.

On September 18, 2018, former California physician Christopher Owens was sentenced to 41 months in prison for unlawfully prescribing oxycodone hydrochloride without a medical purpose. The sentence was handed down by the Judge Alsup, U.S. District Judge in San Francisco, California.

The former Dr. Owens pleaded guilty on March 20, 2018.  In sentencing Dr. Owens, Judge Alsup stated, “[Owens] was not running a pill mill, . . . but he was doing something just as bad . . ..  He used that prescription pad to feed a habit.”  

Dr. Owens acknowledged he prescribed the drugs without a legitimate medical need and outside of the course of medical practice.  According to his open plea application filed with the court, Dr. Owens of Indianapolis, Indiana was a medical doctor when he prescribed oxycodone hydrochloride, a Schedule II controlled substance, to an individual. His guilty plea came after an Indictment. On July 11, 2017, a federal grand jury indicted Dr. Owens charging him with distributing oxycodone without a medical need, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C).  

In addition to the prison term, Judge Alsup ordered Owens to serve three years of supervised release to begin after his prison term is completed and a $7,500 fine. Judge Alsup ordered Owens to surrender and begin serving his sentence on December 3, 2018.  As a consequence of the issues in this case, Dr. Owens lost his license to practice medicine.

 

Psychiatrist Who Saw Patients by "Skype" Pleads Guilty to Health Care Fraud for Treatment and Billing for Workers' Compensation Patients

When health care providers tell me that "telemedicine" is now "legal," I respond that the same standard of care applies and that they need to be very careful regarding how the patients are seen, referred, examined and ensure that the medical record keeping and reports also meet the standard of care. 

Health care providers who do telemedicine as a subcontractor also need to make sure they know who they are working for and how the visit is going to be billed. In addition, they need to see whether they are paying a third party for management fees or billing that could be classified as payment for referrals.

The number of health care fraud cases that arise where the patients have been treated or prescribed after "telemedicine" consultations or exams is on the rise.  A recent case shows how Skype was used to allow a psychiatrist to see patients but it appears the reports and billing may not have met the standard of care and even delved to the abyss of false billing.

Dr. John Thomas Terrence of Marina del Rey pleaded guilty on July 16, 2018  to health care fraud involving the alleged defrauding of California workers’ compensation insurers. This was an Indictment that had been filed in July 2015 and related to conduct from 2005 to 2012. Criminal cases often deal in ancient history or acts occurring years prior. 

Orange County Psychiatrist Arrested on Federal Charges Alleging Illegal Prescriptions for Opioids Without Legitimate Medical Need

The use of undercover officers who pose as "patients" are standard where physicians are charged with prescribing without legitimate medical necessity. A recent case used at least one undercover officer in its investigation.

A psychiatrist Dr. Robert Tinoco Perez who practices at a Santa Ana clinic was arrested on June 30, 2018 by special agents with the Drug Enforcement Administration on federal charges that allege he issued prescriptions for scheduled drugs, such as the opioid oxycodone, without a medical purpose.

    

Dr. Perez was named in a 14-count indictment returned by a federal grand jury on June 27. An indictment contains allegations that a defendant has committed a crime and is not evidence. Every defendant is presumed innocent until and unless proven guilty beyond a reasonable doubt in court.

California Orthopedic Doctor Charged With State Insurance Fraud for Allegedly Providing Unnecessary and Excessive Medical Treatment for Ortho Patients

California county district attorney offices continue to prosecute health care providers for insurance fraud and workers' compensation insurance fraud. They are also using Indictments more often to put more pressure on the defense as a recent case demonstrates.

On May 30, 2018, a San Joaquin County criminal grand jury indicted Dr. Gary Royce Wisner on 11 felony counts of insurance fraud for allegedly defrauding insurers of more than $700,000 for providing unnecessary and excessive medical treatment including x-rays for orthopedic patients.  Dr. Wisner will be arraigned on June 26, 2018 in San Joaquin County Superior Court.  

The case may have overlapped with a Medi-Cal complaint or allegation since in May 2017 the Bureau of Medi-Cal Fraud and Elder Abuse executed a search warrant and seized documents. The investigation was multi-agency and also included the California Department of Insurance and the U.S. Department of Health and Human Services.

Three Orthopedic Surgeons Charged In Los Angeles Federal Indictments Relating to Alleged Kickbacks for Surgeries at Pacific Hospital

Three orthopedic surgeons (David Hobart Payne, Jeffrey David Gross and Lokesh Tantuwaya) have been charged in three separate cases for their roles in alleged kickbacks paid for surgeries performed at now-closed Pacific Hospital. The facts underlying this case were from 2008 to 2013 and this has been a longstanding investigation. The case is pending in the Central District of California in Los Angeles.

All three physicians have plead not guilty.  An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court. 

After Losing At Trial, Mississippi Physician Sentenced to 42 Months in Prison for Role in Prescribing Allegedly Medically Unnecessary Compounded Medications to Patients and for Falsifying Patient Records to Make it Appear He Had Examined Them Before Prescribing

Physicians who consider "telemedicine" or writing prescriptions to patients they have not physically seen or any other unusual arrangement for seeing patients and prescribing medications or supplies should consider a recent case. 

In this case, a 78 year old Mississippi physician, Albert Diaz, M.D., went to trial after the key people in the compounding pharmacy and marketing plead guilty. I often see older or impaired physicians get brought into these arrangements and this case fits the pattern.

On March 2, 2018, after a five-day jury trial, Albert Diaz, M.D. in the Southern District of Mississippi was convicted of one count of conspiracy to commit health care fraud and wire fraud, four counts of wire fraud, one count of conspiracy to distribute and dispense a controlled substance, four counts of distributing and dispensing a controlled substance, one count of conspiracy to falsify records in a federal investigation and five counts of falsification of records in a federal investigation. 

On June 8, 2018, Dr. Diaz was sentenced to 42 months in federal prison and was denied bail pending surrender. According to government evidence presented at trial, between 2014 and 2015, Dr. Diaz participated with others in defrauding TRICARE and other insurance companies by prescribing medically unnecessary compounded medications, some of which included ketamine, a controlled substance, to individuals he had not examined.  The government's trial evidence claimed that, based on the prescriptions signed by Dr. Diaz, Advantage Pharmacy in Hattiesburg, Mississippi, dispensed these medically unnecessary compounded medications and sought and received reimbursement from TRICARE and other insurance companies totaling more than $3 million.