Former Veterans Affairs Psychiatrist Pleads Guilty to Medicare Fraud

As seen in this press Release from the US Department of Justice

Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Wednesday, October 30, 2013

Former Veterans Affairs Psychiatrist Pleads Guilty to Medicare Fraud

Dr. Mikhail L. Presman, a licensed psychiatrist employed by the Department of Veterans Affairs (VA), pleaded guilty today to health care fraud for falsely billing Medicare for home medical treatment to Medicare beneficiaries and agreed to forfeit more than $1.2 million in illegal profits.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta Lynch of the Eastern District of New York, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

According to court documents, from Jan. 1, 2006, through May 10, 2013, Presman submitted approximately $4 million in Medicare claims for home treatment of Medicare beneficiaries notwithstanding his full-time, salaried position as a psychiatrist at the VA hospital in Brooklyn. Contrary to his representations, Presman did not provide any treatment to a substantial number of the beneficiaries he claimed to have treated. For example, Presman submitted claims to Medicare for home medical visits at locations within New York City even though he was physically located in China at the time of these purported home visits. Additionally, Presman submitted claims to Medicare for 55 home medical visits to beneficiaries who were hospitalized on the date of the purported visits.

Presman is scheduled to be sentenced by U.S. District Judge I. Leo Glasser of the Eastern District of New York on Feb. 13, 2014, and faces a maximum sentence of 10 years in prison.

The case was investigated by the HHS-OIG, with assistance from the Department of Veterans Affairs Office of Inspector General, and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Trial Attorney Bryan D. Fields of the Fraud Section and Assistant U.S. Attorney Patricia E. Notopoulos of the Eastern District of New York.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:

http://www.stopmedicarefraud.gov

Did Antidepressant Play a Role in Navy Yard Massacre?

Did Antidepressant Play a Role in Navy Yard Massacre? By John Horgan in Scientific American

Once again, antidepressants have been linked to an episode of horrific violence. The New York Times reports that Aaron Alexis, who allegedly shot 12 people to death at a Navy facility in Washington, D.C., earlier this week, received a prescription for the antidepressant trazodone in August.

 

When I first researched antidepressants almost 20 years ago, I encountered claims that they sometimes triggered violent episodes—for example, a 1989 incident in which a Kentucky man taking fluoxetine (brand name Prozac) shot to death eight co-workers and then himself. I dismissed the claims, reasoning that, because people prescribed psychiatric drugs are disturbed to begin with, it is not surprising that a tiny fraction hurt themselves and/or others.

By 2004, however, in part because of lawsuits that forced pharmaceutical companies to disclose data on adverse effects, the FDA ordered antidepressant manufacturers to include a warning that antidepressants “increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.”

Alexis, who was 34, was reportedly seeking treatment for insomnia when he received his prescription for trazodone. Originally marketed as an antidepressant after its approval by the FDA in 1981, trazodone is also prescribed for anxiety and insomnia. Trazodone was a precursor of the extremely popular selective serotonin reuptake inhibitors (SSRIs); like the SSRIs, trazodone boosts levels of the neurotransmitter serotonin.
A website maintained by the National Institutes of Health states that trazodone and other antidepressants have been associated with “new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement.”

Could trazodone have played some role in the Navy Yard rampage? I put this question to David Healy, a professor of psychiatry at Cardiff University in England and an authority on side effects of psychiatric medications.* He has testified in numerous court cases involving suicides and homicides whose perpetrators were ingesting antidepressants. Healy is not opposed to psychiatric medications–he prescribes them to his own patients—but he has long been active in pointing out medications’ risks. *[Healy and other health-care experts have founded an organization called RxISK to gather data on side effects of drugs. See Postscript.]

Healy responded by email that he “would need to know much more details” to judge whether trazodone might have contributed to this week’s massacre. Indeed, as the Times reported, Alexis had displayed signs of mental illness and acted violently well before being prescribed trazodone. In 2004 he fired bullets into a car in Seattle, during what he described later as a “black out” episode. So far, moreover, there are no reports that he had trazodone in his system during his Navy Yard rampage.

But Healy said that, although data on antidepressants and violence are much more scarce than data on suicide, there is evidence that “you can put healthy volunteers on these drugs and some will become violent.” A study by the Drug Safety Research Unit in Southampton of paroxetine (Paxil) and fluoxetine (Prozac) involving more than 25,000 subjects showed that one out of every 250 subjects were involved in “a violent episode,” including 31 assaults and one homicide, Healy said.

Another study involving more than 9,000 subjects taking the antidepressant paroxetine (Paxil) for depression and other disorders showed that subjects experienced more than twice as many “hostility events” as subjects taking a placebo. Healy added: “I have had clinical experience of at least one older man, with no prior history of violence, who became homicidal after a week on citalopram where the problem cleared up once treatment had stopped.”

Healy suspects that the main causal factor behind suicide and violence toward others is increased mental and/or physical agitation, which leads about 5 percent of subjects taking antidepressants to drop out of clinical trials, compared to only 0.5 percent of people on placebos.
In their excellent overview “Antidepressants and Violence: Problems at the Interface of Medicine and Law,” published in PLoS Medicine in 2006, Healy and two co-authors note that “serious violence on antidepressants is likely to be very rare.” But they call for “more clinical trial and epidemiological data to be made available and for good clinical descriptions of the adverse outcomes of treatment.”
They add: “Legal systems are likely to continue to be faced with cases of violence associated with the use of psychotropic drugs, and it may fall to the courts to demand access to currently unavailable data. The problem is international and calls for an international response.”

Antidepressants and other psychiatric drugs clearly help alleviate mental illness in some patients. But as I have written previously, such medications may on balance harm patients more than they help. We need better data on the risks that these medications pose not only to patients but also to others.

*Postscript: David Healy and other health-care experts from around the world have formed an organization called RxISK to gather data on adverse effects of pharmaceutical drugs, including violence. The RxISK website calls it “the first free, independent website where patients, doctors, and pharmacists can research prescription drugs and easily report a drug side effect–identifying problems and possible solutions earlier than is currently happening.” I hope RxISK succeeds, because we badly need it.

Post-Postscript: For more on links between psychiatric medications and violence, see this 2010 paper in PLOS One, “Prescription Drugs Associated with Reports of Violence Towards Others,” and a followup blog post by journalist Robert Whitaker, author of Anatomy of an Epidemic.

Ex-psychiatrist in Cresco sex case has long history of lewd behavior

As reported in the Pocono Record

Charged in Monroe County with soliciting sex from what he believed to be a 13-year-old boy, a former psychiatrist has had his license revoked in three states including Pennsylvania, and served jail time in New Jersey for lewdness, according to the Pennsylvania Board of Medicine.

[...]

Monroe County District Attorney's Office detectives arrested Kessler at his home Friday.

This resulted from an investigation detectives began in May, after a woman told state police a suspicious adult had been contacting her 13-year-old son on Facebook.

Authorities said this adult, identified as Kessler and using a fake name online, contacted a detective posing as the boy and began a sexual conversation.

Authorities said Kessler, thinking he was still talking to a minor, sent links to pornographic videos, along with a photo of a nude male he identified as himself, and told the detective he wanted to perform oral and other sex. Kessler's license to practice psychiatry in Pennsylvania had been revoked in July 2012 by the Pennsylvania Board of Medicine, said Pennsylvania Department of State spokesman Ronald Ruman. Kessler's license revocation was the latest development in a troubled history that began in 2001. The Board of Medicine's license revocation ruling reveals the following details:

• A graduate of the University of Connecticut School of Medicine and Central Connecticut State University, Kessler was first licensed in 1999 in New York, where in June 2001 he completed a four-year internship/residency at what was then Long Island Jewish Medical Center and Hillside Hospital.
• Kessler later was licensed in Massachusetts.
• On July 1, 2001, he began a residency in a child/adolescent psychiatry program at Cambridge Health Alliance in Massachusetts.
• On July 8, Kessler was charged with "open and gross lewdness" and disorderly conduct, after two men told police he had exposed himself to them and masturbated in his car in a doughnut shop parking lot in Walpole, Mass.
• This prompted Cambridge Health Alliance to fire him from its child/adolescent psychiatry program Aug. 1.
• In November 2001, with the earlier criminal case still pending, Kessler again was charged with open and gross lewdness and indecent exposure.
• Two boys, ages 10 and 12, told police they saw him nude and masturbating in the front window of his mother's Falmouth, Mass., home.
• With two criminal cases now pending against him, and unable to find work since his termination from Cambridge Health Alliance, Kessler returned to New York.
• Because he did not renew his Massachusetts license when it came due in December 2001, the license was labeled "revoked," though not due to any disciplinary action at that time.
• Kessler applied at Brunswick Hospital Center in Amityville, N.Y., and Holliswood Hospital in Queens, N.Y.
• He omitted his Massachusetts employment on both applications, and put "no" when asked on Brunswick Hospital Center's group malpractice insurance policy application if he'd ever been charged with a felony.
• On Dec. 1, 2001, Kessler started working full time at Brunswick.
• On June 2, 2002, Kessler was convicted of open and gross lewdness in the second criminal case in Massachusetts.
• He began the long process of appealing the verdict, but there is no mention of whether he served any jail time, according to state papers.
• On June 3, he pleaded not guilty to open and gross lewdness in the first criminal case, while the disorderly conduct charge in that case had been dismissed, but the matter would be continued for another year.
• In October 2002, Kessler admitted on his New York license renewal application to having been charged with a crime and disciplined by a hospital.

Based on this, the New York Board for Professional Medical Conduct charged him in December 2002 with lying on his hospital job applications about never having faced any criminal charges.

Psychiatrist Frederick Berlin, founder of the Johns Hopkins Sexual Disorders Clinic in Baltimore, testified at the January 2003 board hearing on the charges.

Berlin said Kessler has "a sexual disorder characterized by exhibitionism and an urge to be seen masturbating by young males," but that Kessler at the time was being adequately treated for the disorder.

Psychiatrist Marc Reubins testified Kessler has "a systemic disorder characterized by anxiety and depression," while psychiatrist Seymour Block agreed with the anxiety assessment.

Deeming Berlin's testimony the most convincing, the board in February 2003 found Kessler's actions constituted "fraudulent practice" and "moral unfitness to practice medicine," and revoked his New York license.

Kessler then became a licensed life, accident and health insurance broker in New York, New Jersey, Connecticut and Pennsylvania. He went to work for a New Jersey firm specializing in minimizing health insurance cost increases related to disease management.

He also gave monthly free seminars in New York for high school students and parents on maximizing college financial aid, and prepared state and federal income tax returns for people and businesses.

Meanwhile, the first criminal case against him was finally dismissed in June 2003.

In September of that year, the Massachusetts Board of Registration in Medicine moved to take disciplinary action against Kessler's Massachusetts license based on the conviction in the remaining criminal case and his New York license revocation.

In November 2004, the Massachusetts Supreme Judicial Court overturned the criminal conviction.

Despite this, the Board of Registration in Medicine in July 2006 revoked Kessler's right to renew his Massachusetts license.

The board found he had "undermined public confidence in the integrity of the medical profession, lacked good moral character and had been disciplined by another state for the capacity to deceive and defraud."

After moving to Pennsylvania, Kessler in November 2006 applied to practice medicine in this state.

The Board of Medicine in January 2007 denied his application based on the New York and Massachusetts license revocations.

Kessler and Reubins, the psychiatrist who had testified on his behalf before the New York board, appeared at an October 2007 appeal hearing.

Reubins told the Board of Medicine that Kessler had been in no further trouble since 2001, was getting treatment for his anxiety and wanted to get back into medical practice.

Agreeing with Reubins that Kessler should have another chance to practice medicine, the board in December 2007 granted Kessler a five-year probationary license with terms and conditions, including the successful completion of a board-approved clinical skills evaluation/remediation program.

From October 2008 to June 2009, Kessler worked at ISL Psychiatric Services in Stroudsburg, and then as associate medical director for a school-based partial hospitalization program in Monroe and Northampton counties from July 2009 to May 2011.

He traveled among area schools, treating children with various mental illnesses.

From 2010 until March 2011, Kessler covered for the staff psychiatrist at Shawnee Academy in Shawnee-on-Delaware, a residential treatment facility for children with severe mental illnesses.

He was then at Pocono Psychiatric Associates in Smithfield Township.

But trouble again surfaced in November 2010, when Kessler for the third time was charged with lewdness.

Three juvenile males allegedly saw him masturbating in a vehicle at the Sutton Park Mall in Flanders, N.J.

Kessler in March 2011 pleaded guilty and was sentenced to 90 days in county jail and fined $1,000. This led to his Pennsylvania license eventually being revoked in July 2012.

It's unknown how or if Kessler was employed when charged Friday in the current criminal case.

He was placed in Monroe County Correctional Facility in lieu of $50,000 bail and will appear in district court at a future date.

Disciplinary Hearing of Florida Psychiatrist Ronald Kurlander

As seen in the description on YouTube

On April 5, 2013 in Deerfield Beach, Florida psychiatrist Ronald Kurlander was disciplined by the Florida Department of Health. He was accused of prescribing drugs to people he had never examined or even met. The father of one of Kurlander's patients gave testimony as to the extensive damage caused by these drugs to his son. Kurlander is the one with the moustache and goatee with wire frame glasses seated to he left. He was fined over $30,000.00, given a reprimand, ordered to take a law and rules course, a drug course and a medical records course. Additionally, he has to undergo a risk management assessment.

Why the University of Minnesota psychiatric research scandal must be investigated

As writen by Carl Elliot, and Published on the MinnPost Website

Carl Elliott is a professor in the Center for Bioethics at the University of Minnesota.

Three former editors of the New England Journal of Medicine have called for an investigation. So has the scholar who uncovered the Guatemala syphilis studies. The former Health and Disability Commissioner of New Zealand has called the conduct of the researchers “unethical,” pointing out the need to “put in safeguards in place to prevent a similar tragedy from happening again.” A recent Medical Journal of Australia editorial compared it to the exploitation of poor black men with syphilis in Tuskegee, Ala. Yet the University of Minnesota, where the research scandal occurred, simply keeps repeating, “Nothing to see here, folks. Just move along.”

The research abuse in this case is so stunning that when I first learned about it I could scarcely imagine it happening anywhere, much less at the university where I work. In late 2003, psychiatric researchers at the University of Minnesota recruited a mentally ill young man named Dan Markingson into a profitable, industry-funded research study of antipsychotic drugs. The researchers signed him up over the objections of his mother, Mary Weiss, who did not want him in the study, and despite the fact that he could not give proper informed consent. Dan was acutely psychotic, plagued by delusions about demons, and he had repeatedly been judged incapable of making his own medical decisions. Even worse, he had been placed under an involuntary commitment order that legally compelled him to obey the recommendations of the psychiatrist who recruited him into the study.

For months, Mary tried desperately to get Dan out of the study, warning that he was getting worse and that he was in danger of committing suicide. But her warnings were ignored. On April 23, 2004, she left a voice message with the study coordinator, asking, “Do we have to wait for him to kill himself or someone else before anyone does anything?” Three weeks later, Dan committed suicide in the most violent way imaginable. His body was discovered in the shower of a halfway house, his throat slit so severely that he was nearly decapitated, along with a note that said, “I went through this experience smiling.”

Conflicts of interest, other issues

As outrageous as that sounds, there is more. The psychiatrists had financial conflicts of interest from their work with the pharmaceutical industry. The study sponsor also provided financial incentives for the researchers to keep subjects in the study as long as possible. Last fall, the state Board of Social Work found that the study coordinator had falsified the initials of doctors on study records, failed to warn Dan of new dangers of the study drugs, had been given medical responsibilities far beyond her training as a social worker, and had failed to respond to Mary’s warnings that Dan was in danger of killing himself.

After Dan’s suicide, it got even worse. When Mary’s lawsuit against the university was dismissed on technical grounds of “sovereign immunity,” the university lawyers filed a legal action against her called a “notice to assess costs,” demanding that she pay them $57,000 in legal fees. Yes, you read that correctly: The U tried to force the mother of a suicide victim to pay it $57,000.

None of this is a secret. The case has generated international outrage. Yet for three years the University of Minnesota has managed to bluster and stonewall its way through all the criticism, insisting that it has already been exonerated. Even when the state Legislature passed “Dan’s Law” in 2009, banning psychiatrists from recruiting mentally ill patients under an involuntary commitment order into drug studies, the university continued to insist it had done nothing wrong.

A petition to Gov. Dayton

Two weeks ago, as a last resort, Mary Weiss, the mother of Dan Markingson, and her friend Mike Howard started a petition to Gov. Mark Dayton. Their request is simple: Please appoint an external, impartial panel to investigate the scandal. More than 1,200 people have signed, including well over 150 academic experts. Many University of Minnesota alumni have joined as well. A typical but telling comment: “I am ashamed of my alma mater right now.”

This is not an issue from the distant past. We do not know if other research subjects have died, or if they have been injured or mistreated. We do not even know if mistreatment is still continuing today. That may well be the most compelling reason for Minnesotans to sign the petition. If a case of research abuse this brazen can be sanctioned and defended by the university, there is no way to feel confident that other research subjects are being protected. In 2004 it was Dan Markingson. But it could have been any of us.

Abbott and Costello at the Psychiatrist's Office

A small amount of Satire

California Psychiatrist Suspended for Missing his Own Mental Exam

As seen in this report from The Marin Independent Journal

The state medical board suspended the license of a Mill Valley psychiatrist Thursday for failing to show up for a mandatory psychiatric examination. The board ordered Dr. Brent Taylor Cox to get the test last year after a complaint that he "may be suffering from a substance addiction disorder and/or other mental impairment that may affect his ability to practice medicine safely," according to board documents. The board said Cox did not arrive for his scheduled exam, even though it sent him notices by certified and first-class mail to three addresses and emailed the notice to his Gmail account. The board also sent an investigator to his addresses to serve the letter, but "no one answered the door," board documents said. Regulators moved to discipline Cox, and he appeared for a hearing in November with his attorney, Mitchell Green of San Francisco. Cox agreed to a settlement in which the board suspends his license and gives him 30 days to get the psychiatric testing. Green said the whole dispute exists because Cox never received the initial order to get the psychiatric exam. Cox was in the middle of changing his office location at the time and was no longer using the same Gmail address, but he neglected to update his email address with the board, Green said.

Hat tip to PsychSearch.net for the story