Sixteen Michigan and Ohio-area defendants, including 12 physicians, have been sentenced to prison for a $250 million health care fraud scheme that included the exploitation of patients suffering from addiction and the illegal distribution of over 6.6 million doses of medically unnecessary opioids. The scheme, perpetrated through a multi-state network of pain clinics from 2007 to 2018, involved doctors refusing to provide patients with opioids unless they agreed to unnecessary back injections.
According to the Department of Justice, the evidence established that the clinics were pill mills frequented by patients suffering from addiction, as well as drug dealers, who sought to obtain high-dosage prescription drugs like oxycodone from doctors who agreed to work only a few hours a week to “stay under the radar” of the Drug Enforcement Administration (DEA), yet were among the highest prescribers of oxycodone in the State of Michigan. In some instances, patients experienced more pain from the shots than from the pain they had purportedly come to have treated, and that some patients developed adverse conditions, including open holes in their back. The proceeds of the fraud, over $16 million of which was forfeited by the United States from the defendants, were used to fuel lavish lifestyles, the DOJ said.
16 Defendants, Including 12 Physicians, Sentenced to Prison for Distributing 6.6 Million Opioid Pills and Submitting $250 Million in False Billings
Sixteen Michigan and Ohio-area defendants, including 12 physicians, have been sentenced to prison for a $250 million health care fraud scheme that included the exploitation of patients suffering from addiction and the illegal distribution of over 6.6 million doses of medically unnecessary opioids. Five physicians were convicted in two separate trials, while 18 other defendants pleaded guilty. Seven defendants await sentencing.
“It is unconscionable that doctors and health care professionals would violate their oath to do no harm and exploit vulnerable patients struggling with addiction,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division.
“These are not just crimes of greed, these are crimes that make this country’s opioid crisis even worse – and that is why the department will continue to relentlessly pursue these cases.”
“Patients look to physicians and medical professionals for their expertise and knowledge, trusting that they will do what is best to take care of them,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “In this circumstance, these medical professionals provided prescription drugs to those with no medical need. It is unacceptable that in this nation’s current opioid crisis, physicians and medical professionals are exploiting the well-being of their patients for profit. Thanks to the diligent work of the FBI and our law enforcement partners, we are able to navigate the important sphere of healthcare fraud and to continue our mission of bringing those who operate these criminal schemes to justice.”
“Health care professionals who exploit opioid addiction for financial gain do so at the risk of endangering their patients and undermining critical public health efforts to address the opioid epidemic,” said Special Agent in Charge Mario Pinto of the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG). “We will continue working with our law enforcement partners to ensure that bad actors are held accountable for such egregious disregard for patient safety and well-being.”
“IRS-CI is committed to working with its law enforcement partners to help fight the opioid crisis and to prevent unscrupulous heath care professionals from using taxpayer funded programs as their own piggybanks,” said Special Agent in Charge Sarah Kull of the IRS Criminal Investigation (IRS-CI), Detroit Field Office.
According to court documents and evidence presented at trial, the scheme involved doctors refusing to provide patients with opioids unless they agreed to unnecessary back injections. Perpetrated through a multi-state network of pain clinics from 2007 to 2018, the evidence established that the clinics were pill mills frequented by patients suffering from addiction, as well as drug dealers, who sought to obtain high-dosage prescription drugs like oxycodone. The doctors working at the clinics agreed to work only a few hours a week to “stay under the radar” of the Drug Enforcement Administration (DEA), yet were among the highest prescribers of oxycodone in the State of Michigan.
To obtain prescriptions, the evidence showed that the patients had to submit to expensive, unnecessary and sometimes painful back injections, known as facet joint injections. The injections were selected because they were among the highest reimbursing procedures, rather than based on medical need. Trial testimony established that, in some instances, patients experienced more pain from the shots than from the pain they had purportedly come to have treated, and that some patients developed adverse conditions, including open holes in their backs. Patients largely acquiesced to these unnecessary procedures because of their addiction or desire to obtain pills to be resold on the street by drug dealers. Evidence further established that the defendant physicians repeatedly performed these unnecessary injections on patients over several years and were paid more for facet joint injections than any other medical clinic in the United States.
The evidence further established that the proceeds of the fraud were used to fuel lavish lifestyles. Francisco Patino, a doctor and part-owner of the clinics, bought jewelry, cars and vacations, as well as paid Ultimate Fighting Championship and other mixed martial arts fighters to promote his specialized diet program. Mashiyat Rashid, Patino’s business partner and part-owner of the clinics, purchased private jet flights, courtside tickets to the NBA Finals and expensive real estate. Other physicians involved in the scheme purchased luxury cars, gold bars, and indoor basketball courts and swimming pools. Over $16 million in fraud proceeds was forfeited by the United States from the defendants.
The physicians sentenced by the court include:
Other defendants sentenced by the court include:
The following defendants are scheduled to be sentenced on future dates:
The FBI, HHS-OIG and IRS-CI investigated the case.
Assistant Chief Jacob Foster of the National Rapid Response Strike Force and Trial Attorneys Thomas Tynan, Steven Scott, Kathleen Cooperstein and Shankar Ramamurthy of the Justice Department’s Fraud Section prosecuted the case.
The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this Program, comprised of 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.
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