Assessing Risk Compliance Kickback

Four Doctors, $150 Million, and 6.6 Million Doses of Opioids. What Could Go Wrong?

February 10, 2020

You’d have to be high to think you could get away with it.

“Oxy.” “OC’s”. “Oxycet”. “Oxycotton”. “Hillbilly heroin”. “Berries”. “Killers”. “Percs”. And, “roxi’s”.

Those are all street names for the same drug, a drug with a useful purpose but a drug that is purposefully overused: oxycodone.

In a scam that would make even the other quid pro Joe blush, Joe Betro, D.O, together with Mohammed Zahoor, M.D., Tariq Omar, M.D., and Spilios Pappas, M.D., were found guilty on February 4, 2020, of a $150 million health care fraud scheme in which they forced “patients,” many of them drug dealers or addicts, to undergo expensive, medically unnecessary back injections, as a condition to writing prescriptions for oxycodone and other opioids.

Over the course of the conspiracy, the four convicted physicians, together with 17 other defendants, of whom eight were physicians, all of whom previously plead guilty, were said to have prescribed over 6.6 million doses of opioids. They regularly passed out prescriptions for sky-high dosages of oxycodone meant only for the terminally ill.

But wait, there’s more. Among ordering a plethora of other unneeded and unnecessary ancillary services, all those drug taking “patients” had to be urine screened for drugs — actually, for 56 different drugs for every patient at every visit, regardless of the reason for the visit.

The defendant docs entered standing orders for urine tests for each patient’s every visit, with the tests performed at a lab owned by one of the defendants. The lab then kicked back tens of thousands of dollars to the ordering docs.

On the upside, if you can call it that, the four convicted physicians were fast workers. In a process described at trial as an “assembly-line”, the defendant doctors ranked in the top 25 doctors for dollars paid by Medicare for facet joint injections even though they only worked a few hours a week. Not satisfied with that portion of the “business,” they magically inflated the 15 to 25 patient visits of their 2 to 4 hour shifts, billing Medicare for office visits and procedure codes indicating that they spent as much as 2 hours and 22 minutes with each patient.

Lest you somehow believe (well, perhaps only if you were a patient of one of these fine fellows) that this mess was due to back office clerical errors, the U.S. Attorney reports that every piece of the fraud was consistently implemented and applied to over 94% of their patients.

It almost goes without saying to suggest that you think hard before getting into any arrangement that comes anywhere close to what these doctors did. Yet, in the last decade I’ve seen multiple instances of similar conduct. To be sure, each one came with an “explanation,” if you want to call it that . . . most would call it self-deception.

Depending on inflection, the term “criminal lawyer” can mean one of two things. “Criminal doctor” has only one meaning. The four criminal doctors are scheduled to be sentenced in July.

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