Doctor Who Pleaded Guilty to Health Care Fraud for “Goodie Bags” Agrees to Resolve Civil Fraud and Controlled Substance Liability for $2.8 Million

PHILADELPHIA – U.S. Attorney William M. McSwain announced that the United States filed a civil lawsuit against Andrew M. Berkowitz, M.D., of Huntington Valley, PA, for engaging in healthcare fraud and improperly distributing and dispensing controlled substances. The civil complaint relates to criminal charges that were previously filed against Berkowitz and for which he has pleaded guilty. At the same time the new civil suit was filed, the United States also filed a proposed civil judgment, in which Berkowitz has agreed to pay a total of $2.8 million in civil damages and penalties under the False Claims Act, Controlled Substances Act, and in civil forfeiture, committed to never obtaining another controlled substance registration, and consented to a 20-year exclusion from Medicare and Medicaid. The consent judgment remains subject to court approval.

The civil lawsuit alleges that Berkowitz, through his healthcare practice and employees, developed a scheme where his business dispensed prescription drugs, including controlled substances, to patients in what the staff referred to as “goodie bags.” Berkowitz allegedly dispensed the drugs to every patient whose insurance would cover the drugs he had in stock. The suit alleges that Berkowitz dispensed the drugs for profit without any meaningful assessment of medical necessity or whether the drugs had a legitimate medical purpose. For each “goodie bag” dispensed, Berkowitz allegedly submitted claims for reimbursement falsely asserting that the drugs were medically necessary for the patient. Berkowitz also allegedly prescribed oxycodone to “pill-seeking” patients in exchange for submitting excessive claims to patients’ insurance, including Medicare, for medically unnecessary prescription drugs and for services not rendered. The complaint notes that Berkowitz pleaded guilty to criminal charges on January 24, 2020 and admitted to these facts in court.

Berkowitz agreed to resolve this civil liability under terms outlined in the proposed consent judgment if accepted by the court. Among other things, Berkowitz would pay $2.8 million in civil damages and penalties under the False Claims Act, Controlled Substances Act, and in civil forfeiture, in addition to the $3.5 million he has already agreed to pay in criminal restitution. The proposed resolution would also permanently prevent Berkowitz from prescribing, distributing, or dispensing any controlled substances in the future and prevents Berkowitz from ever seeking another controlled substance registration from the Drug Enforcement Administration. The resolution would also impose a 20-year exclusion on Berkowitz from Medicare and Medicaid.

The civil complaint relates to the criminal charges that were previously filed against Berkowitz. On June 25, 2019, a federal grand jury returned an indictment charging Berkowitz with Health Care Fraud and Distribution of Controlled Substances outside the usual course of professional practice and without a legitimate medical purpose. On January 24, 2020, Berkowitz pleaded guilty to all charges before the Honorable Paul S. Diamond. Describing Berkowitz as a “drug dealer” who committed “prolonged and outrageous dishonesty and fraud,” Judge Diamond revoked bail and remanded him to the custody of the United States Marshal pending sentencing.

 “This civil lawsuit and proposed consent judgment are critical components of ensuring that justice is done in this case,” said U.S. Attorney McSwain. “In addition to criminal charges, this civil resolution makes clear to doctors who dare engage in healthcare fraud and drug diversion that they will be held financially accountable for their illegal conduct. Our office will continue to root out healthcare fraud and drug diversion in the Eastern District of Pennsylvania in all its forms.”

“Andrew Berkowitz pushed unnecessary pills on his patients and doled out opioids to addicts,” said Michael J. Driscoll, Special Agent in Charge of the FBI’s Philadelphia Division. “All the while, he was billing Medicare and insurance companies for it and making multiple millions. It’s a gross violation of both medical ethics and federal law. Alongside the criminal case, these civil actions should help hammer home to the medical community that health care fraud is a crime that truly doesn’t pay.”

“Ensuring the integrity of the Medicare and Medicaid program is a top priority,” said Maureen R. Dixon, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of the Inspector General. “This settlement holds Berkowitz accountable for his misconduct and will bar him for participating in Medicare and Medicaid programs for 20 years. HHS-OIG and our law enforcement partners will continue to investigate and hold accountable those providers who chose to engage in healthcare fraud and drug diversion.”

The case was investigated by the Federal Bureau of Investigation; the Philadelphia Police Department; the U.S. Department of Health and Human Services – Office of Inspector General; the U.S. Office of Personnel Management – Office of Inspector General; and the U.S. Department of Labor – Office of Inspector General. The civil investigation, litigation, and resolution are being handled by Assistant United States Attorneys Anthony D. Scicchitano and Sarah Grieb. The related criminal charges are being prosecuted by Assistant United States Attorney M. Beth Leahy.

The amended complaint contains allegations only; except for what has been admitted in the criminal proceeding, there has been no admissions. The proposed consent judgment would resolve any alleged civil liability.