6 physician fraud cases in September

Here are six physician healthcare fraud cases since Sept. 1: 

1. Santa Ana, Calif.-based physician Mohammed El-Nachef, MD, pleaded guilty to defrauding California's Medi-Cal system by prescribing medically unnecessary drugs to more than 1,000 patients. He was ordered to pay $2.3 million in restitution and surrender his medical license. 

From 2014 to 2016, Dr. El-Nachef prescribed unnecessary HIV medications, antipsychotics and opioids to patients at Los Angeles and Anaheim, Calif.-based clinics. The patients, who were Medi-Cal recipients, were recruited with cash payment promises and then illegally sold the drugs. 

2. Cleveland-based physician Timothy Sutton, MD, was accused of illegally billing Medicare for tests that aim to predict a patients' likelihood of cancer and prescribing braces to patients who didn't need them. 

While working for two telemedicine companies from Jan. 26, 2018, to Oct. 21, 2020, Dr. Sutton allegedly ordered cancer genetic testing and durable medical equipment braces. Cancer genetic testing is only covered by Medicare for patients already diagnosed with cancer. He also ordered unnecessary braces, according to the indictment. 

3. Oakland County, Mich.-based podiatrist Kenneth Mitchell, DPM, was convicted for his role in a $1.8 million healthcare fraud scheme after billing Medicare under another physician's name.

His privileges to participate in Medicare were revoked in 2015. Dr. Mitchell then convinced his partner to enroll in Medicare and open a new clinic, Urban Health Care Group, where he continued to bill Medicare for services using his partner's name. Even when Medicare suspended payments to the clinic after discovering the scheme, he continued to submit false statements using his partner's name. 

4. Denton, Texas-based physician Stanley Charles Evans, MD, pleaded guilty to federal drug trafficking violations. Beginning in 2017, Dr. Evans, 63, allegedly unlawfully prescribed 370,000 dosages of hydrocodone without a legitimate medical purpose at his family medicine practice. 

An investigation began after it was disclosed that Dr. Evans was prescribing opioid prescriptions for patients showing drug-seeking behavior. He would pre-sign the scripts, and many patients would be seen exclusively by the nurse practitioners at his office. 

Dr. Evans pleaded guilty to conspiracy to distribute and dispense controlled substances and healthcare fraud. He faces up to 20 years in federal prison.

5. Ophthalmologist Craig Morgan, MD, and Eye Consultants of Huntington (W.Va) paid $907,075 to resolve allegations that they submitted false claims to Medicare and Medicaid. 

From January 13, 2013 through April 12, 2019, Dr. Morgan administered vascular endothelial growth factor inhibitor injections into the eyes of patients to treat purported wet age-related macular degeneration or other ophthalmological conditions. Prosecutors said these injections were not medically necessary because the patients did not have treatable Wet-AMD or other conditions that would have warranted the invasive treatment.

6. Scranton, Pa., pain management physician Kurt Moran, MD, was sentenced to 140 months in prison for healthcare fraud and illegal distribution of a controlled substance. Dr. Moran, 70, previously pleaded guilty to crimes related to the drug and fraud charges. He admitted as part of his plea agreement to knowingly distributing fentanyl and oxycodone for illegitimate purposes and that they caused the death of one of his patients.

From December 2014 through 2017, Dr. Moran took bribes for prescribing sublingual fentanyl spray to his patients. The spray is meant only for cancer patients with breakthrough pain. Dr. Moran admitted that Insys Therapeutics paid him about $140,000 over two years for the illegitimate fentanyl prescriptions. The company falsely claimed the kickbacks and bribes were payments in exchange for educational presentations.

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