Federal prosecutors have charged six Detroit-area physicians with fraudulently billing Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan in connection with a scheme to hook patients on opioids and then require them to undergo unnecessary procedures to get more pills.
In a December 4 indictment filed in US District Court for the Eastern District of Michigan, the six doctors were charged with illegally billing $464.4 million "for services and equipment that was medically unnecessary, not eligible for reimbursement, and/or not provided as represented."
That sum includes allegedly fraudulent claims for $182.5 million to Medicare, $272.2 million to Medicaid, and $9.2 million to the Michigan Blues. According to the indictment, the scheme began in January 2013 and continued through November 2018.
During this period, the six physicians allegedly wrote prescriptions for more than 13 million dosage units of opioid drugs, including oxycodone, oxymorphone, hydrocodone, and hydromorphone. The indictment charges the defendants with "unlawful distribution of controlled substances outside the usual course of professional medical practice."
Painful joint and block injections
The defendants allegedly prescribed opioids to induce patients to come in for office visits. Once there, if they wanted to get more pills, they were forced to undergo procedures such as painful joint and block injections, according to the indictment. In addition, the doctors allegedly referred some of these patients for medically unnecessary tests, including MRIs.
The lead defendant is Rajendra Bothra, MD, a surgeon who owns the Pain Center, which has clinics in Warren and Eastpointe, Michigan, and the Interventional Pain Center in Warren. The other defendants, all of whom are participating providers in these two entities, include Eric Backos, MD; Ganiu Edu, MD; David Lewis, MD; Christopher Russo, MD; and Ronald Kufner, MD.
According to the Detroit Free Press, Lewis, Edu, and Russo were released on bond. A judge refused to grant bond to Bothra because he was considered a flight risk. The newspaper didn't mention the current status of Backos or Kufner.
It is unclear how much jail time the defendants are facing. However, the indictment stated that they were all subject to the criminal forfeiture of the proceeds from their alleged offenses, including money and/or real property.
India Abroad, writing about Bothra's indictment, noted that he was "one of the most high-profile American Republican Party activists and fundraisers in the 1980s and early 1990s, who even hosted major fundraisers for then-President George H.W. Bush and other senior GOP lawmakers."
In 1999, the article said, Bothra received the Padmashri Award, one of the highest civilian honors in India, for his work with the poor and the sick in that country. He left his US surgery practice every year to spend several weeks working with Indian organizations to increase awareness of HIV/AIDs and drug, tobacco, and alcohol addiction, the publication said.
This is not the only case of fraud involving Michigan pain clinics. Last June, the CEO of Tri-County Wellness, which owned numerous pain clinics in Michigan and Ohio, and four physicians were charged in connection with a $200 million healthcare fraud scheme involving unnecessary prescriptions of controlled substances and harmful injections.