New Charges Added to 2011 Health Care Fraud Indictment
Thirteen individuals from the metro Detroit area have been charged in a large-scale health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today.
The superseding indictment, adds 13 new defendants and new charges to a 2011 indictment, which charged Canton Pharmacist Babubhai ‘Bob” Patel with overseeing a massive health care fraud and drug distribution ring at more than 20 pharmacies that he owned and controlled in metro Detroit.
The 21-count superseding indictment charges with prescription fraud involving 26 Michigan pharmacies. The indictment alleges that the defendants participated in a scheme whereby the owners/controllers of the pharmacies provided kickbacks, bribes, and other illegal benefits to physicians to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance. The prescriptions are presented to one of the defendants’ pharmacies for billing. In exchange for their kickbacks and inducements, the physicians would write prescriptions for the patients and bill the relevant insurers for services supposedly provided to the patients without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of the defendants owned pharmacies, where defendants would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and, in many cases, never provided. Patients were recruited into the scheme by patient recruiters or “marketers,” who would pay kickbacks and bribes to patients in exchange for the patients’ permitting the defendants’ pharmacies and the defendant physicians to bill their insurance for medications and services that were medically unnecessary and/or never provided.
The indictment further alleges a conspiracy to distribute controlled substances at the defendants’ pharmacies to facilitate the submission of false and fraudulent claims to Medicare, Medicaid, and private insurers. According to the indictment, defendants paid physicians kickbacks for prescriptions for controlled substances for their patients and directed those patients to fill the prescriptions at defendants’ owned/controlled pharmacies. The controlled substances included the Schedule II drug oxycodone (Oxycontin), the Schedule III drug hydrocodone (Vicodin, Lortab), the Schedule IV drug alprazolam (Xanax), and the Schedule V drug cough syrup with codeine. According to the indictment, prescriptions for these drugs were written outside the course of legitimate medical practice.
This most recent indictment falls in line with the federal government’s increased investigation and prosecution of health care fraud across the country. In May 2009, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) created the Health Care Fraud Prevention and Enforcement Action Team (HEAT), making the fight against health care fraud a Cabinet-level position. The Heat task force is focused on nine cities including Detroit.