New York man charged with impersonating doctor, potentially providing mental health services to over 100 patients over a three year old.

From this report from Q13 Fox

Donald Lee-Edwards was arrested this week and accused of impersonating a clinical psychologist and medical doctor for three years and potentially providing mental health services to over 100 patients, said the Richmond County District Attorney’s office. He is “a dangerous scam artist who never completed any medical school or doctoral program. He merely bestowed upon himself the professional titles of clinical psychologist and medical doctor,” said Daniel Master Jr., Richmond County district attorney.

According to authorities, Lee-Edwards said he worked “extensively with family members and victims of 9/11” and made himself available for home visits. In June, the district attorney’s office was notified of his practice after skeptical patients complained of his unorthodox bedside manner and his prescription methods. CNN affiliate WCBS spoke to one of Lee-Edwards’ patients, Kim Broadie, outside his office. Broadie showed them a bottle of anti-depressants he had been prescribed with a different doctor’s name; the district attorney’s office said Lee-Edwards would call in his prescriptions under the identity of a different doctor with a similar sounding name.

Lee-Edwards operated out of a basement apartment below a two-family residence in Staten Island; he lived in the floor above his office with his parents, officials said.

Photographs released by the district attorney’s office show a waiting room with seating area, a kitchenette, a front desk and rooms for treatment. They also show shelves of blood vials and urine samples and medical equipment throughout the apartment.

Lee-Edwards’ letterhead advertised him as a clinical psychologist, Ph.D., M.D. and L.P., and when CNN called Lee’s business and cell phone numbers for comment, his voice mail did the same. Lee-Edwards and his attorney, Matthew Blum, could not be reached for comment. The district attorney’s office said during Lee-Edwards’ time practicing, he saw “approximately 10 parolees through word-of mouth referrals” and he would talk to their parole officers about session attendance. He also prepared progress reports for parolee’s files, officials said.

The district attorney’s office brought a 12-count indictment against Lee-Edwards, including charges of criminal impersonation, identity theft, unauthorized practice of medicine, criminal diversion of prescription medications and prescriptions. Lee-Edwards is due back in court in September and is being held on a $150,000 bond/$75,000 bail.

Riverside psychiatrist pleads not guilty in Medicare scheme

Report from the Houston Chronicle

A Houston psychiatrist who was indicted separately in the Riverside General Hospital $160 million Medicare billing fraud scheme pleaded not guilty on Friday and intends to stand trial in August.

Dr. Sharon Iglehart is accused of one federal conspiracy count, two health care fraud charges and a pair of allegations that she made false statements to investigators. At a pretrial conference before U.S. District Judge Ewing Werlein, her lawyers - which include high-powered defense attorney Rusty Hardin - said she is ready to face a jury. Iglehart originally was arrested in December 2013, but the allegations have been amended twice since then - growing from nine to 12 pages in the most recent indictment secured from a federal grand jury and filed on July 21. Iglehart pleaded not guilty to the amended five counts and retained her freedom on $50,000 bail.

Former Riverside CEO and president Earnest Gibson III was convicted as the ringleader in three conspiracies involving Medicare billings for Riverside's psychiatric treatment programs from 2005 to 2012 in which patients were ineligible for treatment or were warehoused but did not receive the reported care. The government alleged that $31 million in fraudulent reimbursement requests were paid. His son, former group home owner Earnest Gibson IV was also convicted at trial and sentenced to 20 years.

The elder Gibson received the heaviest punishment so far: 45 years. His second-in-command, Mohammad Khan, received a 40-year sentence. They received some of the nation's longest sentences for health care fraud - particularly, stealing from the Medicare or Medicaid programs, which is one of the top criminal prosecutorial priorities for the U.S. Justice Department.

Through her Iglehart Wellness Center, the psychiatrist allegedly participated in the scheme by submitting claims that falsely indicated she provided intensive outpatient services for severe mental illness through Riverside's treatment program. Iglehart retains an active medical license in Texas. She was reprimanded by the Texas Medical Board in 2009 for "recreating medical records for psychiatric patients significantly later than the time she had provided examination, diagnosis and treatment to the patients," according to the agency's website. Her disciplinary status was cleared in 2011.

Jury selection in Iglehart's case is set for Aug. 31. If convicted, the doctor faces up to 10 years in prison on each count. Regina Askew, who rose from a case worker to become an auditor, will spend 12 years in prison.

In July, Sharonda Holmes, who was involved in paying and receiving kickbacks, was sentenced to 3½ years and Waddie McDuffie became the sixth person to receive prison time in the scam that crippled Riverside. The historic Third Ward institution began as Houston's first hospital for black patients and became one of the state's largest providers of substance abuse and mental health treatment. McDuffie pleaded guilty to delivering kickback money to group home owners in exchange for them sending patients for mental health treatment at the hospital. He received a five-year term of probation and six months of home confinement. Those who have pleaded guilty or were convicted at trial are among the dozen defendants who are jointly responsible for $46 million in restitution.

All of the Riverside cases are being prosecuted by Washington-based lawyers assigned to the Justice Department's criminal fraud division.

Anchorage Doctor Sentenced to 3 ½ years for Fraudulently Billing Medicaid and Tampering with Physical Evidence

State of Alaska Press Release here

The Alaska Department of Law, Medicaid Fraud Control Unit, announced today that 40-year-old Dr. Shubhranjan Ghosh was sentenced to 3 ½ years of active incarceration. Dr. Ghosh pled guilty to Medical Assistance Fraud and Tampering With Physical Evidence, which he committed between 2010 and 2013 at his practice, Ghosh Psychiatric Services.

Judge Philip Volland also ordered Dr. Ghosh to repay $605,000 in restitution to Medicaid. After release, Dr. Ghosh will be on probation for 10 years, and there will be 3 ½ years jail time that the Court could impose if he violates probation. Dr. Ghosh was remanded to custody at sentencing today. The Medical Board will decide the future of Dr. Ghosh’s medical license.

In court papers, Assistant Attorney General Jonas Walker argued that Dr. Ghosh “is a con artist who happens to hold a medical license.” The State presented evidence at sentencing, including a video showing Dr. Ghosh urging an employee to sign false affidavits stating that medical services were provided when, in fact, they were not.

Judge Volland remarked the community should be “shocked” by Dr. Ghosh’s “unconscionable and unacceptable” crimes of “poaching” money from a program designed to provide medical care to a particularly vulnerable population.

The case was initiated by citizen complaint and jointly investigated by the Alaska Department of Law, Alaska State Troopers, Anchorage Police Department, Alaska Department of Health and Social Services, the U.S. Department of Health and Human Services, Office of Inspector General, Federal Bureau of Investigation, Immigration and Customs Enforcement Homeland Security Investigations. Mr. Walker emphasized that this case is a great example of how state and federal collaboration can work to combat fraud and abuse in the Medicaid system.

The Alaska MFCU is part of the Attorney General’s Office. The MFCU is responsible for investigating and prosecuting Medicaid fraud and abuse, neglect or financial exploitations of patients in any facility that accepts Medicaid funds.

The information filed in the Ghosh complaint can be found on the MFCU website.

Poor treatment at Lehigh Valley mental health clinics was evident, patients say

From a longer report in the Lehigh Valley Live website

Photo caption:Lehigh Valley Community Mental Health Centers Inc. at 226 Northampton St., Easton, is seen July 20, 2015. It is one of 10 mental health clinics sued July 20, 2015, by the U.S. Attorney's Office for the Eastern District of Pennsylvania, along with owner Melissa Chlebowski and Melchor Martinez. Martinez is alleged to have run the Medicare- and Medicaid-funded clinics in Easton, Bethlehem, Allentown, Philadelphia and Raleigh, North Carolina, despite a 2000 ruling excluding him from participating in these and any federally funded health care programs.

Director Allison E. Frantz said the department received complaints about the delivery of care at Lehigh Valley Community Mental Health Centers Inc., now the target of a federal whistleblower lawsuit. The department forwarded the complaints, prompting an investigation, she said.

"The Northampton County DHS has taken steps to ensure the county's citizens' behavioral health treatment would not be jeopardized: the provider network was enhanced to include additional bi-cultural, bilingual treatment professionals and regular and frequent on-site clinical reviews, including additional billing audits," Frantz wrote in an email Tuesday.

After the U.S. Attorney's Office for the Eastern District of Pennsylvania announced the lawsuit Monday, patients were left with myriad questions about the care they had received and whether the five local centers in Easton, Bethlehem and Allentown would remain open.

The suit also targets the centers' owner, Melissa Chlebowski, and her husband, Melchor Martinez, both of Allentown, as well as four sister mental health centers in Philadelphia and one in North Carolina.

[...]

The suit alleges the mental health clinics used unqualified stand-ins for psychiatrists and rushed patients through "medication management" visits. Federal prosecutors also say the centers were really run by Martinez, despite being prohibited since 2000 from participating in Medicaid, Medicare or any federally funded health care programs.

The civil action seeks damages and penalties.

[...]

Owners of local mental health clinics face fraud charges

As Reported in the Philadelphia Business Journal

The U.S. Attorney’s Office for the Eastern District of Pennsylvania filed a civil health care fraud lawsuit Monday, under the False Claims Act, against an Allentown husband and wife and their network of mental health centers funded largely by Medicaid and Medicare.

The lawsuit names Melchor Martinez and Melissa Chlebowski, both of Allentown, as defendants and their businesses: Northeast Community Mental Health Centers in Philadelphia; Lehigh Valley Community Mental Health Centers in Allentown, Easton and Bethlehem; and North Carolina Community Mental Health Centers in Raleigh, N.C.

The complaint notes Martinez was convicted of Medicaid fraud in 2000 and, as a result, was excluded from participating in all federally funded health care programs including Medicaid and Medicare. The exclusion prohibited Martinez from owning, managing or receiving payments from any federally funded health care provider.

The lawsuit alleges that in spite of the exclusion, Martinez, assisted by his wife Chlebowski, continued to own and operate the Northeast and Lehigh Valley clinics, and that, in 2009, while his exclusion was ongoing, he started up the North Carolina clinic in Raleigh.

The complaint also says the clinics billed Medicaid for psychiatrist visits “of very brief duration, sometimes as little as two to three minutes, while fraudulently representing that patients were being seen for a 15 minute visit.”

The Northeast and Lehigh Valley clinics allegedly billed Medicaid and Medicare for the services of “therapists” who were not qualified to provide mental health services, and fraudulently billed Medicare for therapy services allegedly provided without the required supervision.

The complaint did not specify the damages being sought by the government.

The matter was investigated by the U.S. Department of Health and Human Services’ Office of Inspector General and the U.S. Attorney’s Office for the Eastern District of Pennsylvania, with assistance from the Pennsylvania Office of Attorney General and the North Carolina Department of Justice.

Psychiatric Drugs Are False Prophets With Big Profits - Psychiatry has been hijacked

From a column in Psychiatry Today by Robert Berezin M.D. While I do not think that psychotherapy is very workable, his criticism of psychiatry is spot on.

Once again, I just finished another consultation with someone from out of state who was desperate to find a therapist who he could talk to. He didn’t want to be pigeon holed into some DSM-5 reductionistic diagnosis. He didn’t want psychiatric drugs. He was desperate to find a psychiatrist who would understand him, who he could relate to, and could treat him with real psychotherapy. There should never have been a reason for me to consult with anyone from out of state. Unfortunately, the cynical and fraudulent takeover of psychiatry is all but complete. How many real psychiatrists are left?

How did this happen? Over the course of my career, I kept my head down and devoted myself to my craft, psychotherapy. I was certainly aware of the collusion between the APA and the drug companies. But as recently as ten years ago, I honestly did not know that things had really deteriorated this far.

Apparently, Dr. Jeffrey Lieberman and other like-minded psychiatrists, decided that psychoanalysis had too much power, and they wanted to transform the APA once again to the tenets of somatic psychiatry. The underling theory of somatic psychiatry is that the source of human struggle is considered to be the brain itself, rather than the person.

Treatments that follow from this simplistic, mechanistic, and reductionist notion have been to act directly on the brain, always with violating and destructive outcomes.

Somatic psychiatry originated with seizure therapy, or its first modern incarnation, insulin shock therapy (IST). It actually had its roots in the sixteenth century and was used psychiatrically around the time of the American Revolution. It was refined in 1927 into insulin shock therapy, when insulin was used to induce seizures as a treatment for drug addiction, psychopathy, and schizophrenia, with claims of a 50 percent remission rate. Papers were published in the American Journal of Psychiatry, starting in 1937. IST was widely used through the 1940s and 1950s. Its founding etiological principle was the (false) idea that seizures were the opposite of schizophrenia. Induce a seizure, and you balance out psychosis. In the 1930s, a more refined scientific explanation was developed for the (phantom) curative power of seizures. Its science proclaimed that psychiatric problems came from the autonomic nervous system. IST was said to work by blocking the nerve cells of the parasympathetic nervous system, thereby intensifying their tonus and strengthening their anabolic force. This restored the nerve cell, and the patient recovered. The corollary theory was that patients were jolted out of their psychiatric condition.

Next, we have lobotomies, originally called leucotomies. Lobotomies came onto the scene in the 1930s, having been invented and promoted by Antonio Egas Moniz. When I was a psychiatric resident, lobotomies were still fresh in psychiatric memory. The practice had only ceased in the early 1960s, after over twenty thousand people received this “treatment.” Let’s see … what was the science? The source of psychiatric problems was located in the brain, specifically the prefrontal cortex. The treatment of choice, then, was to ream out the prefrontal cortex with an ice pick. Respected MDs had a miracle cure and were the vanguard of the field. Science proved that lobotomies cured not only schizophrenia but anxiety, depression, low self-esteem, obsessive/compulsive disorder, and the unwanted behavioral problems associated with mental retardation (this is code for sexual behaviors). It was respected and celebrated in the psychiatric literature and validated in journals with documented studies and peer-reviewed scientific evidence. Lest you think this is an exaggeration, Moniz won a Nobel Prize in 1949 for his great and wonderful discovery.

Eventually, the validating follow-ups were shown to be fabricated and deluded, with self-promoting lies and half truths. Only after a great deal of harm were they debunked. And the ice picks were thrown into the trash heap of psychiatric history. We need to add that after lobotomies gradually attenuated, no one stopped and said, “What in the world did we just do?” How could sticking an ice pick in someone’s brain ever have been even a remote consideration? What was going on that such a grotesque medieval mutilation was actually adopted as a good thing to do? And how could it have been publicly and professionally embraced? However, as always seems to happen, amnesia quickly set in, and we forgot the brutal inhumanity that was so recently celebrated. And the considerable body of discredited scientific validation was never scrutinized for its contribution to and for having promoted such harm. Instead, science moved on to support the next somatic treatment in exactly the same way.

Next, we have electroconvulsive therapy (ECT), which came along soon after IST, in 1938. ECT was still a part of the curriculum in my own psychiatric residency in 1971. Entire psychiatric hospitals, built exclusively for ECT, were still operating, with no empty beds. Scientific studies and respected journals provided documented validation for placing electrodes on patients’ heads and applying huge jolts of electricity to generate seizures. Apparently, the jolt theory had gained traction. So we shocked the brain, instead of reaming it out. How humane. In addition to everything else, ECT also was touted as a cure for depression. It was allegedly proved that ECT was a safe, effective cure, with few, if any, drawbacks. The resultant memory loss not only was initially downplayed but was trumpeted as being therapeutic. (By the way, drugs are being developed today to chemically erase memories with the idea that this is therapeutic for trauma—same thing.) Later, under public pressure, ECT was refined to cut down on memory loss. The history of electroconvulsive therapy followed the same trajectory as lobotomies. Eventually, ECT showed itself to be the ineffective and violating practice that it is. But don’t get overconfident. Incredibly, in recent years, ECT has made a comeback and is being promoted once again, when its progeny treatments, antidepressants, don’t work.

Finally, we come the current incarnation of somatic psychiatry - neurobiological psychiatry, and its so-called treatment—drugs. Psychiatric drugs are next in the lineage of “treatments” whose focus is to act upon the physical brain. History is repeating itself.

Our contemporary science has now apparently proven that human problems come from genetic or developmental neurobiological disorders of the physical, anatomical, biochemical brain. The somatic treatments for these neurobiological, genetic, synaptic hormonal neurotransmitter diseases are brain drugs—psychoactive drugs.

In one generation, the APA, in collusion with the drug companies have destroyed psychiatry. The American Public has been sold a bill of goods.

People actually believe that human struggle is a brain disease. It is now taken as fact that there is a chemical imbalance in the brain and psychoactive drugs is just what the doctor ordered. We can now cure biological depression with antidepressants; biological anxiety with benzodiazepines; the fictitious ADHD with, of all things, amphetamines; insomnia with benzodiazepines, and other bizarre psychoactive drugs; Likewise the belief is that schizophrenia and manic-depression should be treated with drugs [...]

Houston Hospital Leaders Sentenced to 45 Years in Prison for Alarming Psychiatric Fraud Scheme

Details of the fraud allegations against Riverside General Hospital executives

The bulk of the Medicare and Medicaid fraud allegations against Gibson, et al. center around Riverside’s psychiatric facilities, which are classified by the government as a “partial hospitalization program” (PHP) A PHP is technically an outpatient treatment facility, but is geared toward the round-the-clock care required for patients enduring a severe mental illness. Under government guidelines, mental health patients receiving care at a PHP must be routinely seen by a psychiatrist, guided through a care plan, and carefully monitored throughout the course of treatment.

According to the allegations, Riverside collected more than $158 million in funds from Medicare and Medicaid on behalf of PHP patients who rarely, if ever, saw a psychiatrist for their illnesses. Moreover, Riverside regularly billed the government for psychiatric services that were never rendered, mostly because the patients were in the advanced stages of dementia and unable to participate in the treatment.

Patient care aside, Riverside is also accused of offering kickbacks and financial incentives to executives group homes, as well as recruiters tasked with increasing referrals of mental health patients to Riverside’s facilities.

In addition to the three main participants listed above, six other individuals recently pled guilty to conspiring with Gibson to bring in the maximum number of Medicare and Medicaid clientele.

According to a statement by the U.S. Attorney General’s Office, “The former President of Houston’s Riverside hospital, his son, and their co-conspirators saw mentally ill, elderly, and disabled Medicare beneficiaries as commodities to be turned into profit centers – not as vulnerable individuals in need of health care….Rather than providing needed medical care to a historically underserved community, the defendants ran a longstanding hospital into the ground through their greed and fraud. According to the evidence presented at trial, the defendants had patients sit around the facility watching movies while they received no treatment. Meanwhile, the defendants billed Medicare more than $158 million for care that was never provided. This brazen fraud cannot and will not be tolerated.”

See Also

Department of Justice Press Release, “Former President of Riverside General Hospital Sentenced to 45 Years in Prison in $158 Million Medicare Fraud.” June 9, 2015.

Fairfield psychiatrist charged with fraud. They submitted bills that added up to them seeing patients 24 hours a day.

The state attorney general is suing a Westport couple for Medicaid fraud, charging they submitted bills that added up to them seeing patients 24 hours a day.

Attorney General George Jepsen announced Thursday morning that Dr. Ashwini Sabnis, a psychiatrist, and her husband Saurav “Sam” Mohanty, co-owners of Brighter Concept, Inc., 2000 Post Road in Fairfield, allegedly filed false claims under the Connecticut Medical Assistance Program. The couple also operated a Brighter Concept office in New Haven.

Jepsen said he is seeking triple damages under the state’s False Claims Act for actions that occurred between January, 2010 and December of last year, including billing for services that garnered higher reimbursement levels than the services they actually provided. Jepsen alleged that the couple overbilled the state Department of Social Services by $768,171 during the four-year period.

The lawsuit, pursued by Jepsen and Department of Consumer Protection Commissioner Jonathan Harris, was filed in Hartford Superior Court.

"This action is being brought to seek damages, civil penalties and other relief due to a scheme that was perpetrated on a health care program intended to care for our most vulnerable citizens," Jepsen said in a statement. "Health care providers who accept taxpayer dollars must play by the rules."

The couple’s attorney, Ross Garber, declined comment.

The 42-page complaint alleges that the scheme included claims for services not rendered, as well as overbilling and filing false statements in a “systematic and persistent pattern of submitting false and fraudulent claims.” The lawsuit alleges that Sabnis and Mohanty discouraged auditors from the state Department of Social Services with claims that their computer system had crashed.

Sabnis regularly overbooked her scheduled Medicaid patients for 15 or 30 minute appointments, saw them for as little as 5 or 10 minutes, then used a reimbursement code that showed she spent as much as 75 to 80 minutes with them, the complaint said. The lawsuit alleges that there were 113 days when Sabnis billed the state for more than 24 hours of service for low-income and disabled patients.

Department of Social Services Commissioner Roderick L. Bremby praised the Attorney General’s investigation.

“Uprooting and eliminating this type of fraudulent activity requires the constant vigilance of oversight agencies,” Bremby said. “While the great majority of Medicaid-enrolled providers are professional and honest, the exceptions require aggressive action on behalf of the program’s overall integrity and the taxpayers who fund it.”

The Devious Matrix Called Psychiatry

A new Blog entry by Jon Rappaport entitled The Devious Matrix Called Psychiatry

A very long article well worth the read. Here's the intro

“Psychiatry does more than define mental disorders. It purports to describe actual states of mind, and it coalesces and freezes those descriptions in such a way that people believe these states of mind exist. They don’t. They’re fictions. Fantasies. This is an enormous landscape of consciousness-programming. It’s actually reduction. Like many systems before it, psychiatry tries to reduce the possibilities of wide-ranging free consciousness. Throughout history, people have always been afraid of mind freedom. ‘What will people with free minds do?’ ‘What will society become if people’s minds are free?’ I can tell you: society would change radically, right down to its foundations.” (The Underground, Jon Rappoport)

Over the past 30 years, my work has always returned to freedom of the individual.

Not only Constitutional freedom and Bill-of-Rights freedom, but liberation of the power of individual thought and imagination and invention. Because those qualities are unpredictable, open-ended, and limitless. This is where long-term revolution begins.

So naturally, I’ve investigated the premier “science” that claims to have the best understanding of the mind: psychiatry.

I was neither surprised nor shocked to discover that psychiatry is a fraud, a pseudoscience.

Yet, this “science” is accorded special treatment and licensure and favored status by governments around the world. Why? Because untold numbers of patients can be diagnosed and drugged with highly toxic substances, and even held against their will in closed wards. Dissidents can be contained. Whole populations can be convinced they are either “mentally healthy” or “mentally ill,” as if those two fictional categories described some highly significant status.

If psychiatry were merely recognized as an experimental hypothesis, and so-called professionals diagnosed one another and applied labels to one another and drugged one another, in order to assess the outcome, as any scientist would, before subjecting the public to his idiosyncratic notions…well, fine. I could understand that.

But of course, this is not where we find ourselves. Psychiatrists are considered lofty authorities. They are called as expert witnesses in criminal trials. Then can, in many cases, arbitrarily force their will on patients. They are called upon by media to render their analyses. They occupy sanctified chairs at universities.

So…with that introduction, let me present information which has not been broadly communicated to the public.

Gay Conversion Therapy Trial: New Jersey Nonprofit Group In Fraud Trial For Claiming To Cure Homosexuality

Another case where Shrinks do not know what they are doing, and end up getting sued for it. From a report from the International Business Times (Warning, autoplay video on website)

A major challenge to “gay conversion” therapy is ramping up in New Jersey, in a case that critics of the controversial treatments hope will set a precedent for fighting the practice around the country. A group that offered the so-called therapy is scheduled to go on trial for fraud Wednesday in the state, one of only three to have banned licensed therapists from offering treatments that purport to change a person’s sexual orientation.

Four men and two of their mothers are suing the nonprofit group Jews Offering New Alternatives for Homosexuality, or Jonah, on the grounds that it fraudulently claimed that it could change patients’ sexual orientation and for characterizing homosexuality as a mental disorder, the Associated Press reported. The plaintiffs have accused the group of engaging in “unconscionable practices,” including making patients strip naked during therapy sessions and subjecting them to slurs regarding their homosexuality.

Lawyers for the group have countered that scientists are still debating the nature of sexual orientation, including whether it is fixed or changeable, as well as whether conversion therapies are actually harmful. They have also accused the plaintiffs of seeking to "shut down the debate by making one viewpoint on the issue literally illegal," the AP said.

[...]

In recent years, several states have moved to ban the therapy over fears that it could subject young people to psychological damage but only New Jersey, California, Oregon and Washington, D.C., have succeeded in passing and implementing bans. But the current bans apply only to licensed therapists who practice gay conversion therapy on minors, which is why prosecuting Jonah for consumer fraud could set an important precedent, according to Jack Drescher, a New York psychiatrist and one of the most vocal critics of these therapies.

“A win by the plaintiffs will undoubtedly have a chilling effect on practitioners of SOCE [sexual orientation change efforts] beyond the borders of New Jersey,” Drescher said in an interview with the Huffington Post. “A win would also expand the ban on SOCE embodied in existing legislative bans in CA, NJ, OR and DC: They only apply to licensed professionals who do SOCE with minors. Consumer fraud laws can be used against non-licensed practitioners and protect adult patients as well.”

Psychiatrist who practiced in Nashua allegedly used fake prescription to get drugs

Report from the Union Leader

A Nashua psychiatrist has been arrested by state narcotics investigators and charged with using a bogus prescription to obtain a scheduled drug, N.H. State Police said.

Robert C. Vidaver, 50, of Henniker, was arrested by Henniker police, according to a statement issued Tuesday by the Narcotics and Investigations Unit of the state police.

State police said the arrest followed a four-week investigation, which started after the NIU’s Drug Diversion Section received a complaint about Vidaver.

He is charged with obtaining a controlled drug by fraud.

According to an online listing at the New Hampshire Board of Medicine, Vidaver is a psychiatrist who works at Harbor Homes, a Nashua organization that provides housing, health care, employment, job training and supportive services to the poor and disabled.

Vidaver’s license was issued in 2007 and is set to expire on June 30.

After his arrest, Vidaver was released on his own recognizance. He is scheduled to appear in Hillsborough District Court on July 28.

During A Raid on A Psych Hospital, The FBI has a hard time getting Pizza Delivery

Although everyone thinks of this as a joke, it has been verified by Snopes as a real event

FBI agents conducted a "search and seizure" at the Southwood Psychiatric Hospital in San Diego, which was under investigation for medical insurance fraud. After hours of poring over many rooms of financial records, some sixty FBI agents worked up quite an appetite. The case agent in charge of the investigation called a local pizza parlor with delivery service to order a quick dinner for his colleagues.

The following telephone conversation took place:

Agent: Hello. I would like to order nineteen large pizzas and sixty-seven cans of soda.
Pizza man: And where would you like them delivered?
Agent: To the Southwood Psychiatric Hospital.
Pizza man: To the psychiatric hospital?
Agent: That's right. I'm an FBI agent.
Pizza man: You're an FBI agent?
Agent: That's correct. Just about everybody here is.
Pizza man: And you're at the psychiatric hospital?
Agent: That's correct. And make sure you don't go through the front doors. We have them locked. You'll have to go around to the back to the service entrance to deliver the pizzas.
Pizza man: And you say you're all FBI agents?
Agent: That's right. How soon can you have them here?
Pizza man: And you're over at Southwood?
Agent: That's right. How soon can you have them here?
Pizza man: And everyone at Southwood is an FBI agent?
Agent: That's right. We've been here all day and we're starving.
Pizza man: How are you going to pay for this?
Agent: I have my check book right here.
Pizza man: And you are all FBI agents?
Agent: That's right, everyone here is an FBI agent. Can you remember to bring the pizzas and sodas to the service entrance in the rear? We have the front doors locked.
Pizza man: I don't think so.

Click.

As Snopes explains:

Origins: The above-quoted tale about FBI agents trying to arrange for pizza delivery to a psychiatric hospital is one of those pieces that serves to remind us that no matter how bizarre, far-fetched, or incredible a story may seem at first glance, it should never be entirely discounted without at least some effort being made to verify it.

This anecdote began circulating on the Internet in 1995, often attributed to a "Center for Strategic and International Studies report on GLOBAL ORGANIZED CRIME" or "a talk by R. James Woolsey, Director of Central Intelligence, given at a conference on global organized crime." We initially reproduced it on our site with no judgment as to its truth or falsity, expecting that it would eventually be revealed as a work of creative fiction by some Internet prankster. To be thorough, we sent a routine inquiry to the FBI's San Diego office about the story and then promptly forgot about it, assuming that the FBI had much better things to do than spend their time debunking silly tales spread via e-mail.

We were quite surprised, therefore, when several weeks later we received a response from FBI Special Agent Wayne A. Barnes, who confirmed for us that the incident described was real and supplied us with additional background detail about it.

In 1993, the FBI was assisting the Department of Health and Human Services in investigating health care fraud. A medical organization that operated psychiatric hospitals in nine different cities had come under suspicion, and law enforcement agencies had scheduled coordinated raids on all nine of those facilities to take place on the same day (so that none of the hospitals could alert the others). The unexpectedly high volume of records seized in a morning raid on the Southwood Psychiatric Hospital in Chula Vista, California, meant that the investigation there turned into an all-day affair. When the agent in charge of the operation realized his men were running on empty after long hours with no food, he attempted to order pizza from a local delivery outfit, placing the call now immortalized in this piece. Contrary to what is stated in most versions of this piece, though, the FBI was not taping all of the hospital's calls that day; the conversation reproduced above was reconstructed from the memories of agents present at the event.

And yes, the FBI men did get their pizzas, but the food was not delivered to the hospital — several agents had to drive over to the restaurant and pick up their pies.

N.J. medical bribe scheme reached grand scale

Selections from the extensive report on NewJersey.com

The first hint of the vast bribery scheme came with the arrests of a North Jersey doctor and three businessmen who, authorities said, found a way to turn a diagnostic lab with offices in Parsippany and Garfield into a virtual gold mine.

Two years later, federal prosecutors in Newark have racked up convictions of 38 people, including 25 doctors from New Jersey, New York and Connecticut, in what is believed to be one of the largest — if not the largest — laboratory bribery prosecutions in the United States, both in terms of money and the number of physicians caught with their hands out.

“To our knowledge, this is the largest number of medical professionals ever prosecuted in the same case,” U.S. Attorney Paul J. Fishman said last week.

“It shows how pervasive this practice can be. It has also made people in the profession sit up and take notice and made the deterrent message that much louder,” he said.

In recent weeks two doctors, one weeping and both remorseful, have been sentenced after helping prosecutors catch others in cases that add to the broadening panorama of corruption.

By the numbers

• 25 doctors and one physician’s assistant pleaded guilty to accepting bribes.
• 16 of the doctors live in New Jersey; seven in New York; and two in Connecticut. The physician’s assistant is also from New Jersey.
• 12 other defendants who worked at Biodiagnostic Laboratory Services have pleaded guilty.
• The amount of bribes pocketed by individual doctors ranged from $10,500 to $1.8 million.
• In return for bribes, the doctors referred over $100 million in blood tests to the lab.
• So far, 12 doctors have been sentenced to terms ranging from one year of probation, for a cooperator, to more than three years in federal prison and fines of up to $75,000.

The government is seeking a combined forfeiture of more than $87 million from the 38 defendants, including $50 million from former BLS owner and president David Nicoll and $25 million from his brother, Scott Nicoll.

And it’s not over. Additional arrests of doctors who profited from the scheme are anticipated, prosecutors say.

Here is the section we are interested in from this extensive report on this large and complex scheme

A psychiatrist from Fort Lee, who practiced in Paterson, and a doctor from Ramsey are among 12 physicians who have already been sentenced. The psychiatrist, Claudio Dicovsky, admitted accepting $220,000 from BLS, but put a halt to the payments long before the feds came knocking. In January, he was placed on probation for three years, including one year of house arrest with electronic monitoring, and ordered to perform 1,500 hours of community service.

16 separate hospitals and their respective corporate parents have agreed to collectively pay $15.69 million related to fraudulent billing of psych services

Press Release From the US Department of Justice

Sixteen Hospitals to Pay $15.69 Million to Resolve False Claims Act Allegations Involving Medically Unnecessary Psychotherapy Services

The Justice Department announced today that 16 separate hospitals and their respective corporate parents have agreed to collectively pay $15.69 million to resolve False Claims Act allegations that the providers sought and received reimbursement from Medicare for services that were not medically reasonable or necessary, the U.S. Department of Justice announced today. 

“Hospitals that participate in the Medicare program must ensure that the services they provide and bill for are based on the medical needs of patients rather than the desire to maximize profits,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “The Department of Justice is committed to ensuring that those who seek to abuse the Medicare program will be held accountable for their actions.”

This case concerns claims to Medicare for Intensive Outpatient Psychotherapy (IOP) services.  IOP services represent a continuation of ambulatory psychiatric services and provide active treatment to individuals with mental disorders using a variety of treatment methods.  Medicare will pay for an appropriate course of IOP treatment provided a number of specific requirements are met including, most notably, that the services in question are reasonable and necessary for the diagnosis and treatment of the patient’s condition.

These settlements resolve allegations that, beginning as early as 2005 and in some cases continuing into 2013, the hospitals knowingly submitted claims for IOP services that did not qualify for Medicare reimbursement because: the patient’s condition did not qualify for IOP; the patient’s treatments were not provided pursuant to an individualized treatment plan designed to help the patient address specific mental health needs and reach achievable goals; the patient’s progress was not being adequately tracked or documented; the patient received an inappropriate level of treatment; and/or the therapy provided was primarily recreational or diversional in nature, and not therapeutic.  The IOP services in question were typically performed on the providers’ behalf by Allegiance Health Management (Allegiance), a post-acute healthcare management company based in Shreveport, Louisiana, but billed to Medicare by the providers.

The providers who have reached agreements to resolve these allegations with the United States include:

• Health Management Associates Inc. (HMA), and the following 14 hospitals formerly owned and operated by HMA: Central Mississippi Medical Center in Mississippi, Crossgate River Oaks in Mississippi, Dallas Regional Medical Center in Texas, Davis Regional Medical Center in North Carolina, East Georgia Regional Medical Center in Georgia, Gilmore Regional Medical Center in Mississippi, Lake Norman Regional Medical Center in North Carolina, Lehigh Regional Medical Center in Florida, Medical Center of Southeastern Oklahoma in Oklahoma, Natchez Community Hospital in Mississippi, Northwest Mississippi Regional Medical Center in Mississippi, Santa Rosa Medical Center in Florida, Southwest Regional Medical Center in Arkansas, and Summit Medical Center in Arkansas, which agreed to collectively pay $15 million;

• Community Health Systems and its subsidiary Wesley Medical Center in Mississippi, which agreed to pay $210,000; and

• North Texas Medical Center in Texas, which agreed to pay $480,000.

In October 2013, the United States resolved similar allegations with LifePoint Hospitals Inc. and two of its subsidiaries, PHC-Minden L.P., doing business as Minden Medical Center, and PHC-Cleveland Inc., doing business as Bolivar Medical Center, which collectively paid $4,672,469.80.

“This case demonstrates that the U.S. Attorney’s Office for the Eastern District of Arkansas will aggressively pursue civil health care fraud cases, where the integrity of the Medicare system has been undermined,” said U.S. Attorney Christopher R. Thyer of the Eastern District of Arkansas.  “Medical care providers who abuse Medicare hurt all taxpayers, and today’s announcement highlights our commitment to protecting our national health care system, as well as the Arkansans who depend on it.”

“Our agency is dedicated to investigating health care fraud schemes such as this, which divert scarce taxpayer funds meant to provide for legitimate patient care, including services for the often underserved mentally ill population,” said Special Agent in Charge Mike Fields of U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG).

The allegations resolved by today’s settlements arose from a lawsuit filed under the False Claims Act.  The act allows private individuals known as “relators” to sue on behalf of the United States and to share in the proceeds of any settlement or judgment that may result.  The relator in this case will receive $2,667,300. 

These settlements were the result of a coordinated effort by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Eastern District of Arkansas and HHS’ Office of Audit Statistics and OIG.

These settlements illustrate the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $24 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs.

The claims settled by these agreements are allegations only, and there has been no determination of liability. 

Queensland Health psychiatrist accused of having bogus qualifications

A Report from ABC News (Australian Broadcast Co)

A hearing has begun into a former Queensland Health psychiatrist who worked as a doctor with allegedly bogus medical qualifications.

Vincent Victor Berg was employed as a psychiatrist at the Townsville General Hospital's mental health unit between July 1999 and January 2002. Concerns about the authenticity of the Russian-born migrant's medical qualifications only came to light during the Tony Morris led Health Inquiry in 2005. Berg is facing 22 charges including 10 counts of uttering, six counts of fraud, five counts of attempted fraud and one count of forgery.

During the first day of the committal hearing in the Southport Magistrates Court, arresting officer Detective Sergeant Steven Bignell said Berg sent allegedly fake psychiatric qualifications from the Voronezh University in Russia to the Australian Medical Council.

The sergeant told the court he travelled to Russia to speak with staff at the university and was told they did not offer a psychiatric course in 1977 when Berg claimed to have studied there. The detective tendered a letter from the Russian university that stated Berg's qualifications were a "crude forgery". Berg's Queensland Health photographic identification card was also tendered to the court showing he was employed in the Townsville Hospital as a medical registrar.

The Russian migrant was charged by police in 2009 and it has taken six years for the matter to progress to the committal hearing stage. The long delay has been due in part to Berg previously representing himself and seeking a number of adjournments. Legal Aid stepped in late last week and the defendant is now being represented by criminal lawyer, Michael Gatenby.

The hearing continues.

Physician Sentenced for $5.5 million Medicare fraud scheme involving fraudulent billings by a psychiatric hospital

As seen in this report

A Miami-area medical doctor was sentenced recently to 60 months in prison for his role in a $5.5 million Medicare fraud scheme involving fraudulent billings by a psychiatric hospital in Hollywood, Florida.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Barry Kaplowitz, 54, of Aventura, Florida, a licensed physician, was convicted of making false statements related to health care matters on Feb. 20, 2015, following a six-week jury trial. In addition to the recent prison sentence, U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida ordered Kaplowitz to pay more than $2.9 million in restitution.

According to evidence presented at trial, Kaplowitz served as the medical director at Hollywood Pavilion (HP), a state-licensed psychiatric hospital, from approximately 2008 to 2011. During that time, Kaplowitz signed false and fraudulent medical records in order to make it appear that HP’s patients qualified for and received intensive outpatient services, even though they did not. The evidence demonstrated that Kaplowitz signed patient files for over 400 patients certifying that he had provided mental health services to each of them, even though he never saw nor provided any treatment to the patients. HP used these falsified medical records to submit over 2,800 false claims to Medicare totaling over $5.5 million. Medicare paid $2.9 million on those false claims.

Five other individuals have previously been convicted and sentenced in this case:

• Karen Kallen-Zury, of Lighthouse Point, Florida, HP’s former chief executive officer, was sentenced to 25 years in prison;
• Daisy Miller, of Hollywood, the clinical director of HP’s inpatient facility, was sentenced to 15 years in prison;
• Michele Petrie, of Fort Lauderdale, Florida, the head of HP’s intensive outpatient program, was sentenced to six years in prison;
• Christian Coloma, of Miami Beach, Florida, the director of physical therapy for an entity associated with HP, was sentenced to 12 years in prison; and
• Christopher Gabel, of Davie, Florida, HP’s former chief operating officer, was sentenced to six years in prison.

Dr Peter Gøtzsche exposes big pharma as organized crime (Youtube Video)

Twenty-Three Defendants – Including Nine Doctors – Charged With Enterprise Corruption in Massive $7 Million Medicaid Fraud

From this press Release from the BROOKLYN DISTRICT ATTORNEY'S OFFICE in the State of New York

Brooklyn District Attorney Ken Thompson, together with United States Health and Human Services Office of the Inspector General New York region Special Agent in Charge Scott J. Lampert, New York City Human Resources Administration Commissioner Steven Banks and the New York State Acting Medicaid Inspector General Dennis Rosen, today announced that nine doctors are among 23 defendants named in a 199-count indictment that alleges they participated in a massive scheme in which they lured people recruited from low-income neighborhoods, homeless shelters and welfare offices to corrupt medical clinics for unnecessary tests with the promise of free footwear such as sneakers, shoes and boots. District Attorney Thompson said, “These defendants allegedly exploited the most vulnerable members of our society and raked in millions of dollars by doing so. The many poor people who were allegedly targeted at homeless shelters, welfare offices and soup kitchens and referred to as ‘guinea pigs’ by the defendants were exploited for hours, if not days, just because they needed a pair of shoes. That so many doctors allegedly participated in this elaborate scheme to defraud a health care system designed to help the poor is truly disgraceful.” [...] In some cases, the patients were referred for psychiatric care or pain management. These referrals would then generate recurring visits for which they could bill. [...] It is further alleged that Herbert Meadow, MD, Renee Denobrega, NP, and physician’s assistant Matthew Jordan provided psychiatry services to patients, and charged inflated fees for abbreviated patient visits. They also referred patients to others in the enterprise for costly, frequent and unnecessary tests and procedures. Meadow was the owner of record for Community Medical Disorder P.C., and Vainer opened and was the sole signer of its bank account initially. Meadow is presently the sole signer, and both shared the profits generated by the billings.

This is a very large and complex investigation, and a lot of people were involved

Five arrested in East Cove Psychiatric Services investigation

As seen here

Agents with the North Carolina State Bureau of Investigation executed search warrants Tuesday morning at a Kinston psychiatric facility. That afternoon, authorities arrested East Cove Psychiatric Services’ owners and operators Joanna Wolicki-Shannon and Walter Shannon. Shannon, 64, faces 12 felony counts of obtaining a controlled substance by fraud or forgery and received a $180,000 bond. Wolicki-Shannon, 50, received charges of six felony counts of obtaining a controlled substance by fraud or forgery and took a $90,000 bond. According to the SBI, “The doctors wrote bogus prescriptions for phentermine, hydrocodone, Percocet, Adderall, vyvanse and Ritalin using their psychiatric practice employees and members of the office staff’s families to submit them to pharmacies to be filled. The employees picked up the prescribed drugs and delivered them to the doctors.” Agents arrested three others in connection to the case. Lisa Renay Lankford, 53, faces 18 felony counts of obtaining a controlled substance by fraud or forgery and received a $279,000 bond. Candice Raegan Hill, 35, and James Howington, 31, were charged with 10 felony counts each of obtaining a controlled substance by fraud or forgery along with 10 felony counts of trafficking opium. Hill received a $650,000 bond, while Howington received a $659,000 bond. Hill and Lankford are both former office managers at East Cove, and Howington is Hill's boyfriend. East Cove’s main office is located in the 1300 block of North Queen Street, while an additional facility is open Thursdays on Limehouse Road in Kenansville. East Cove serves Eastpointe region clients who require mental health, developmental disability and/or substance abuse services. State agents are being assisted by the FBI in the case. Throughout the day Tuesday the Lenoir County Sheriff’s Office also lent assistance at the scene. The suspects should make their first appearance in Lenoir County District Court on Wednesday.

How the American opiate epidemic was started by one pharmaceutical company

An extended article investigating a corrupt pharmaceutical company Here are some snippets. Well

The state of Kentucky may finally get its deliverance. After more than seven years of battling the evasive legal tactics of Purdue Pharma, 2015 may be the year that Kentucky and its attorney general, Jack Conway, are able to move forward with a civil lawsuit alleging that the drugmaker misled doctors and patients about their blockbuster pain pill OxyContin, leading to a vicious addiction epidemic across large swaths of the state.

A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.

On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales for its manufacturer, Stamford, Connecticut-based pharmaceutical company Purdue Pharma. By 2000 that number would balloon to $1.1 billion, an increase of well over 2,000 percent in a span of just four years. Ten years later, the profits would inflate still further, to $3.1 billion. By then the potent opioid accounted for about 30 percent of the painkiller market. What's more, Purdue Pharma's patent for the original OxyContin formula didn't expire until 2013. This meant that a single private, family-owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.

[...]

Starting in 1996, Purdue Pharma expanded its sales department to coincide with the debut of its new drug. According to an article published in The American Journal of Public Health, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy," Purdue increased its number of sales representatives from 318 in 1996 to 671 in 2000. By 2001, when OxyContin was hitting its stride, these sales reps received annual bonuses averaging over $70,000, with some bonuses nearing a quarter of a million dollars. In that year Purdue Pharma spent $200 million marketing its golden goose. Pouring money into marketing is not uncommon for Big Pharma, but proportionate to the size of the company, Purdue’s OxyContin push was substantial.

[...]

The state of Kentucky's lawsuit against Purdue Pharma is not the first legal trouble the company has run into. In 2007, in United States of America v. The Purdue Frederick Company, Inc., Purdue and its top executives pleaded guilty to charges that it misled doctors and patients about the addictive properties of OxyContin and misbranded the product as "abuse resistant." Prosecutors found a "corporate culture that allowed this product to be misbranded with the intent to defraud and mislead." Purdue Pharma paid $600 million in fines, among the largest settlements in U.S. history for a pharmaceutical company.

[...]

Kentucky is filing a total of 12 claims against the company, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages. In total the suit could cost Purdue Pharma $1 billion (which is just one-third of its annual revenues from OxyContin).

No state has been more devastated by the nationwide opiate problem than Kentucky. Much of the eastern part of the state and the Appalachians has watched as men, women, and teenagers fell victim to the potent pain pills. There were several different gateways — back injuries, operations, parents' medicine cabinets — but all of them led to an implacable addiction that rivals that of the hardest street drugs. And that’s the rub. Because there was simply so much OxyContin available for over a decade, it trickled down from pharmacies and hospitals and became a street drug, coveted by teens and fiends and sold by dealers at a premium (prices often shot up well over $1 a milligram, pricing the popular 80mg tablets at over $100 for a single pill).

Whatever the gray areas on OxyContin's many paths to perdition, the statistics on the first decade of this century bear out a staggering epidemic. From 1999 to 2010, the sale of prescription painkillers to pharmacies and doctors' offices quadrupled. In the exact same time span, the number of overdose deaths from prescription painkillers also quadrupled, rising to almost 17,000.

To call this a coincidence would be analogous to declaring no connection between loosening enforcement on drunk driving laws and observing a sudden increase in deaths caused by drunk driving. It goes almost without saying that these figures dovetail seamlessly with the release of OxyContin and Purdue's marketing timeline, which hit hardest in the early 2000s.