Pain management doctor convicted of paying kickbacks
In 2009, our Corporate and Financial Investigations department and law enforcement began receiving complaints about a Warren-based doctor who claimed to specialize in pain management. One Blue Cross Blue Shield of Michigan member said that his stolen insurance card had been used at the clinic by an individual trying to get narcotics. Another member said his wife had been contacted by a recruiter and told that she could get prescriptions for narcotics from this doctor.
Other tenants at the medical office building where the practice was located complained to police about the crowds that were gathering in the parking lot and hallways of the building while individuals waited for hours to be seen by this doctor.
Joint investigation by the FBI, DEA, U.S. Department of Health and Human Services-Office of Inspector General and Blue Cross Blue Shield of Michigan revealed that patients were getting prescriptions for narcotics for no medical purpose. Patients were recruited to come to the office and agree to diagnostic tests. In return, they would receive cash or prescriptions for Vicodin, Oxycontin, or Opana ER. Some patients agreed to get prescriptions for narcotics and then immediately turn them over to the recruiter. The recruiters were filling the prescriptions for resale on the streets.
In a typical visit, a patient would agree to medical tests such as blood tests, breathing tests, EKGs, EEGs, ultrasounds, X-rays, and psychological testing, no matter what their supposed medical problems were. The testing was all done before being seen by the doctor. All these tests were being billed to Blue Cross Blue Shield of Michigan and Medicare. The investigation revealed that for some of the tests that the clinic billed, the equipment was broken or the clinic did not even own the necessary equipment.
The doctor was initially charged in federal court with health care fraud. In a plea agreement, the doctor pled guilty to the charge of paying kickbacks. He was sentenced to 1 ½ years in jail and his medical license was suspended. At the time of his arrest, the government seized $883,452 in assets from the doctor which he has since forfeited. Those funds will be used to repay Blue Cross Blue Shield of Michigan and Medicare for the false claims.
Blue Cross Blue Shield of Michigan members who suspect health care fraud should call our Anti-Fraud Hotline at 1-800-482-3787 or report fraud through our website.