Health Care Fraud Blog

According to an article in the South Florida Sun-Sentinel, at least 45 pain clinics opened in Broward and Palm Beach counties in the past year, while state law makers and state and local law enforcement agencies stepped-up their efforts to put an end to the operation suspected “pill mills.”

In August 2008, 66 pain clinics were open for business in Broward and Palm Beach counties combined. The Sun-Sentinel article reports that according to data available from the Florida Department of Health, the number centers issuing narcotic pain medications currently is more than the times what it was in August 2008 - with 122 in Broward to 122 and in Palm Beach County to 108.

Pain clinics “are proliferating despite our efforts," Broward Sheriff Al Lamberti said last week, after state and federal agents executed search warrants at three pain clinics owned or controlled by Christopher and Jeffrey George in Palm Beach County. The Georges' homes were also searched.

No arrests have been made yet, however, a federal law law suit has been filed in U.S. District Court in West Palm Beach. According to the law suit, three of the Georges’ clinics collected $14 million last year and dispensed more than 2.1 million pills. [To read the law suit, click: here.] Additionally, five doctors who worked at the clinics have had their DEA numbers to prescribe pain medications suspended. The doctors can either voluntarily agree to the suspension or can challenge the suspension before a DEA Administrative Law Judge at a hearing scheduled for May.

Independent sources close to the investigation indicate that patient files were properly documented, regular MRI's were required and prescriptions that issued were 100% medically necessary. From time to time, patients who were suspected of phony symptom ology were discovered, refused treatment and escorted off the premises. If you or someone you know has ever suffered from debilitating pain, then no one has to tell you that life can be pure hell without taking pain medication just to get through the day and attempting to perform even the simplest of tasks. The real tragedy in the "gung-ho, rah, rah" attitude of law enforcement targeting pain clinics, is that the overwhelming majority of patients have well-documented injuries requiring pain medication for treatment. These legitimate pain sufferers are the forgotten "victims" who unfortunately wind up as unintended by-product caught in the overreaching net of law enforcement, much like innocent dolphins caught in the nets of profit-driven commercial fisherman.

Palm Beach County and several cities in both counties have temporarily banned new pain clincs, reported by the HCFB here and here. "Palm Beach County is ahead of us [in law enforcement efforts aimed at detecting criminal activities at pain clinics]. We're [Broward County is] trying to play catch up now," Lamberti said. "On the street, [there are] too many targets, not enough deputies. We're really trying to be hard on it because it causes crime in the community. We think they know we are serious."

To read the Sun-Sentinel article, click here.

In an intriguing development in the war on pain, Palm Beach County, Florida, passed an ordinance designed to prevent new pain clinics from opening up and are intending to pass ordinances to curb the practices of existing pain clinics. This is a somewhat unusual development and may form the basis for legal challenges. The county commissioners, with some harsh words for pain clinics, are apparently attempting to regulate the medical profession through zoning regulations.

To read more, click: here.

Sometimes it takes some knowledge of how prosecutions generally work to see through press releases and newspaper articles touting big victories by the government. The State of Florida issued a press release yesterday regarding the conviction of a so called “pill mill” operator on charges including adulteration and misbranding of drugs related to the internet sales, without a prescription, of $10 million dollars worth of drugs including controlled substances.

The scheme sounds pretty nefarious. Abel Rodriguez was convicted for his role in setting up pharmacies that didn’t operate except to purchase drugs from wholesalers and passing those drugs on to bought the drugs from wholesalers and then sent the drugs to co-conspirators who then sold the drugs out of warehouses via the internet without a doctor’s prescription.

Generally, you would expect the individual to be charged, as most are in these types of cases, with charges more severe than misbranding and adulteration, which under Florida law at the time were lower level felonies and had previously been misdemeanors. However, a review of the court docket indicates that in fact Mr. Rodriguez was charged with not only drug trafficking, but also racketeering, one carrying mandatory minimum imprisonment and the other with sentences up to thirty years in prison.

What the article and press release do not disclose is that those charges were dismissed by the court. Therefore, the victory was likely not as great as the State and federal government probably anticipated when they charged Mr. Rodriguez in 2005. Of course Mr. Rodriguez is certainly looking at possible prison time, but certainly not as much as he would be if the greater charges survived.

The federal agents arrested 20 people for a Palm Beach operation that engaged in buying up oxycontin from Broward County pain clinics and pharmacies and shipping those drugs to Tennessee, Kentucky, West Virginia, Virginia and North Carolina . The operation had been going on for several years, with participants visiting up to five pain clinics a day to obtain drugs.

To read more, click here.

Dr. Jeffrey Freidlander of Lakeland , Florida was charged in the Middle District of Florida with trafficking in controlled substances including oxycontin, morphine and hydrocodone. The indictment alleges that the physician pre-signed prescriptions and allowed his staff of non-physicians to issue a large number of prescriptions for controlled substances. However, latest Indictment also alleges health care fraud for a number of purported types of false claims to Medicare including submitting claims for physical therapy procedures done by massage therapists.

In addition, the physician and several of his staff are charged with submitting claims for anesthetic procedures required to be performed by a physician called facet joint injections when in actuality unsupervised staff were performing much less expensive and complex trigger point injections.

The Medicare fraud allegations are the result of a superseding indictment (click here and here), that is, new charges added to the original indictable offenses. This apparently arises from the cooperation of one of the staff who had entered into a plea agreement with the government. Although the Medicare related allegations, if proven, would constitute fraud; it is generally not the types of fraud often pursued criminally by the federal government unless the dollar amounts are substantially high. It certainly appears that the fraud is the dog wagging the tail of the drug trafficking allegations. It would be interesting if that is also the route pursued in other investigations related to the dispensing of pain medications although most practices that specialize in pain management do not also provide other types of services reimbursable under Medicare.

For more click here.