California Doctor Arrested in Health Care Fraud Crackdown

By Grace Austin
Inside Subprime: November 11

A California physician has been found guilty of ripping off millions in a Medicare scheme.

A federal grand jury found a doctor guilty of seven counts of health care fraud and adulteration of a medical device in October 2019. His practice was based out of Southern California.

Federal authorities say the doctor concocted a $12 million scheme (which he personally received about $4.5 million from) in which he performed unnecessary medical procedures on people that receive Medicare benefits. During the six-day trial, the Department of Justice found that, for three years, the doctor recruited these Medicare beneficiaries, gave them false diagnoses, and performed procedures they didn’t need.

The doctor would tell the patients they had venous insufficiency, a condition that prevents veins in the legs from getting blood to flow to the heart.

After performing the unnecessary procedures, he would bill them to Medicare using the wrong code, which would allow the doctor to get more money back, an action known as “upcoding.”

As to the second charge of adulteration of a medical device, the DOJ said the doctor repackaged single-use catheters.

The doctor operated two clinics in the area. He was also charged with grand theft and money laundering in a separate 2014 case, in which he pleaded not guilty.

The doctor was arrested in June 2016 as part of a nationwide crackdown on federal health care fraud. More than 300 other people throughout the country were charged in the investigation. And every kind of health care professional was seemingly involved — everyone from pharmacists to occupational therapists to psychiatrists. Overall, authorities say about $900 million was scammed, and officials say many times military families were targeted.

The DOJ said that pharmacies were involved in the majority of the crimes in Southern California in the latest federal health care crackdown.

“Compounding pharmacies were provided with large numbers of prescriptions, generally for pain medications, that carried huge reimbursements, often more than $15,000 for each prescription,” according to the DOJ. “The prescriptions were written by doctors who received kickbacks from marketers or from ‘telemedicine’ websites that had little or no contact with patients.”

In a separate case, a Southern California marketer pled guilty to receiving illegal kickbacks as high as 65 percent after referring people to get drugs at pharmacies that billed TRICARE, according to a local newspaper. He received almost $1 million in kickbacks through that fraud scheme.

The investigation also included officials from the FBI, the Department of Health and Human Services and the U.S. Food and Drug Administration.

The doctor is scheduled to be sentenced in March before a federal judge.

Officials are stepping up health care fraud prosecution nationwide. Since its start in March 2007, the Medicare Fraud Strike Force has now charged more than 4,000 people who have billed the Medicare program for nearly $19 billion.

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