Six Michigan Doctors Charged in $464 Million Insurance and Opioid Scheme
Six Michigan doctors have been charged with insurance fraud and unnecessarily prescribing opioids to patients in a $464 million scheme, according to court documents filed this week by federal prosecutors.
The 56-count indictment, filed on Tuesday and made public on Thursday, named Dr. Rajendra Bothra, 77, of Bloomfield Hills, who owned and operated the Pain Center USA in Warren and Eastpointe, Mich., and the Interventional Pain Center in Warren. The other five doctors were employed by the clinics, which catered to patients with joint and spinal injuries.
As part of the scheme, Dr. Bothra “sought to bill insurance companies for the maximum number of services and procedures possible with no regard to the patients’ needs,” the United States attorney’s office for the Eastern District of Michigan, which filed the charges, said in a statement on Thursday.
Jeffrey Crapko, a lawyer for Dr. Bothra, declined to comment on the case. An after-hours operator at the Pain Center USA said the federal authorities had raided and closed the offices.
The doctors have been charged with submitting false claims to Medicare, Medicaid and Blue Cross Blue Shield and diverting the proceeds to themselves, the indictment said.
According to the Pain Center USA’s website, Dr. Bothra is a surgeon who has practiced in Warren for 30 years and has specialized in pain management for the past five years. The five other doctors who worked with him and are named in the indictment are Eric Backos, 65; Ganiu Edu, 50; David Lewis, 41; Christopher Russo, 50; and Ronald Kufner, 68.
From early 2013 until last month, the doctors issued 13.2 million doses of popular opioids, including OxyContin, Percocet, Vicodin and Dilaudid, according to the indictment. They also performed unnecessary medical services like magnetic resonance imaging on patients. Other charges included billing insurance companies $975 for braces and $2,400 for anesthesia. Prosecutors said the doctors submitted claims of $182.5 million to Medicare, $272.6 million to Medicaid and $9.2 million to Blue Cross Blue Shield of Michigan.
“The damage that opioid distribution has done to our community and to the United States as a whole has been devastating,” Matthew Schneider, the United States attorney for the Eastern District of Michigan, said in the prosecutors’ statement. “Health care professionals who prey on patients who are addicted to opioids in order to line their pockets is particularly egregious.”
The case in Michigan was jointly investigated by the Department of Health and Human Services, the Office of Inspector General and the F.B.I., as well as other agencies.
In October 2017, President Trump announced that his administration was declaring the opioid crisis a national public health emergency. According to recent figures from the Centers for Disease Control and Prevention, 70,237 Americans died from drug overdoses in 2017, a record.
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