Another day, another health care practitioner sentenced for healthcare fraud. A 50 year old Detroit-area pharmacist, Babubhai “Bob” Patel, was recently sentenced to 17 years in prison for a drug scam in which Mr. Patel billed the government and private payers $57 million. The scheme led to the indictment of 26 people, including four physicians. What makes this story interesting is the length of the sentence Mr. Patel received, the number of people involved, and the brazen nature in which he and the physicians involved operated.
Mr. Patel owned and operated 26 pharmacies in the Detroit area, many of which he owned through straw owners in order to conceal his involvement. He staffed some of these pharmacies with Indian pharmacists, whom he allegedly helped come to the US, and then used their employment visas to keep them involved in the scheme, according to an Assistant US attorney quoted in an Associated Press article.
Three of these pharmacists, who were found guilty in November 2012 along with Mr. Patel, will serve 68 months in prison and will then be deported to the country of their citizenship.
The scope of the fraud is almost breathtaking. According to the indictment, Mr. Patel would pay kickbacks to physicians and podiatrists to write prescriptions, or sign blank prescriptions, for both controlled and non-controlled substances. The physicians were allegedly paid $500 to sign stacks of blank scripts. According to the AP, when the doctors decided they wanted more than $500 for their signature, they would tell Mr. Patel, “Ah, my hand is getting tired”. These scripts were then used to dispense unnecessary medications, or in many cases, the payer was billed but no medications were dispensed at all.
Mr. Patel paid patient “recruiters” to farm the streets in 15-occupant vans looking for people in homeless shelters and soup kitchens who would accept $100 payments in exchange for their Medicare/aid numbers, which would then be used for illicit prescriptions.
So how many drugs did the Patel pharmacies dispense? Also according to the indictment, since January 2009:
…not less than 250,000 doses of Oxycontin, not less than 4.6 million doses of Vicodin, not less than 1.5 million doses of Xanax, and not less than 6,100 pint bottles of codeine cough syrup.
When all was said and done:
…the Patel Pharmacies billed the Medicare program not less than $37.7 million for medications purportedly provided to Medicare beneficiaries over the course of the scheme (since January 2006), and not less than $20.8 million for medications purportedly provided to Medicaid beneficiaries over the course of the scheme.
In addition to the jail sentence, Mr. Patel was ordered to pay $17.3 million to Medicare/aid and $1.5 million to Blue Cross/Blue Shield. Mr. Patel has been held without bond since August 2011, and he will receive credit for his time served.
So what about the physicians involved? The ones without whom this scam would have not been possible or at least a lot harder to perpetrate? Two have pled guilty and two are awaiting trial. I do not know what the sentences were for the two who pled guilty.
Interestingly, according to the state of Michigan’s Department of Licensing and Regulatory Affairs website, of the three physicians whose names appear in the indictment, only one no longer has a medical license, and that is only because it lapsed. Not only that, but there are no open formal complaints against any of them.
It would seem to me these physicians, at least the ones who have pled guilty, should have already been called to the carpet by the medical board, or at the very least had a formal complaint lodged. Perhaps they only very recently pled guilty and the “system” has not had time to deal with them.
At least I hope that’s the case. I shudder to think the Michigan medical board would do nothing at all.
A 50-year-old Canton pharmacist who owned and operated 26 pharmacies in the metro-Detroit area was sentenced today to 17 years in prison, U.S. Attorney Barbara L. McQuade announced today.
McQuade was joined in the announcement by Robert D. Foley, III, Special Agent in Charge, Federal Bureau of Investigation; Robert Corso, Special Agent in Charge, Drug Enforcement Administration; and Lamont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services.
U.S. District Judge Arthur J. Tarnow sentenced Babubhai “Bob” Patel on 26 convictions for a health care fraud conspiracy, a drug conspiracy, and related fraud and drug violations.
Evidence presented at a six-week jury trial concluding in August 2012 showed between 2006 and 2011, the pharmacies billed Medicare and Medicaid more than $57 million. At least 25 percent of those billings were for drugs that were either medically unnecessary never dispensed. Additional amounts were fraudulently billed to private insurers such as Blue Cross Blue Shield of Michigan. The pharmacies operated on a business model that paid kickbacks to physicians in exchange for writing prescriptions for expensive medications. The affiliated doctors would also write prescriptions for controlled substances, without regard to medical necessity, which would be filled at the pharmacies and distributed to paid “patients” and patient recruiters. The expensive, non-controlled medications would be billed but not dispensed.
In sentencing the defendant, the court told the defendant that “what you have done is reprehensible.” The criminal conduct engaged in by other health care fraud violators sentenced by the court was “small scale compared to this.”
“Taxpayers fund Medicare and Medicaid to provide health care to needy Americans,” McQuade said. “It is gratifying to see courts impose strong sentences on defendants who exploit these programs for personal gain.”
FBI Special Agent in Charge Foley stated, “Those individuals who engaged in this health care fraud scheme stole millions of dollars over several years from a system designed to provide health care to those in need. The FBI is committed to stopping these illegal acts and prosecuting these criminals.”
“The conduct that occurred in this case was deplorable, inexcusable, and dangerous,” said Lamont Pugh, III, Special Agent in Charge of the Chicago Region of the U.S. Department of Health and Human Services, Office of Inspector General. “The OIG will continue to work with our law enforcement partners to combat prescription drug fraud in the Medicare and Medicaid programs and seek to ensure the safety of program beneficiaries and taxpayer dollars.”
Of the 26 defendants charged in the original indictment in this case, 20 defendants have either pleaded guilty or been convicted at trial. Six defendants are scheduled for trial in June. Out of 12 pharmacists charged, 11 have been convicted at trial or pleaded guilty, with one waiting to be tried. Out of four doctors charged, two have pleaded guilty, with two waiting to be tried.
Earlier this week, Judge Tarnow sentenced several of the other pharmacists who were convicted at trial. Brijesh Rawal, 36, of Canton; Ashwini Sharma, 34, of Novi; and Lokesh Tayal, 36, of Northville, were each sentenced to terms of imprisonment of 68 months for their participation as pharmacists in these criminal offenses. These three pharmacists were non-U.S. citizens who entered the United States under a visa program for certain skilled workers, and each will be deported to the country of their citizenship upon the completion of their sentences. Defendant Rawal is a citizen of Canada, while defendants Sharma and Tayal are citizens of India.
In addition to the prison sentence, defendant Babubhai Patel was ordered to pay restitution to the Medicaid and Medicare programs in the amount of $17.3 million and restitution to Blue Cross Blue Shield in the amount of $1.5 million. Defendant Patel, who has been held without bond since his arrest on August 2, 2011, will receive credit toward his sentence for the time he has served.
U.S. Attorney McQuade thanked the Drug Enforcement Administration; the FBI; the Department of Human Services, Office of Inspector General; and Blue Cross and Blue Shield of Michigan for their tireless work in the investigation and prosecution of the case. The case is being prosecuted by Assistant United States Attorneys John K. Neal and Wayne F. Pratt.