Western District of Pennsylvania Participated in Largest Health Care Fraud Enforcement Action in Department of Justice History
PITTSBURGH – United States Attorney Scott W. Brady today announced, as part of a nationwide health care fraud enforcement action, three Pittsburgh-area doctors were charged and two medical professionals – a doctor and a Suboxone clinic manager – pleaded guilty to unlawfully dispensing and distributing controlled substances and health care fraud. U.S. Attorney Brady’s announcement followed a national announcement by Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, of the largest ever health care fraud takedown by the Medicare Fraud Strike Force which involved 601charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.
"Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer," said Attorney General Sessions. "In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever."
"Every single day, 91 Americans and 13 Pennsylvanians die from an opioid overdose. To attack this scourge, the U.S. Attorney’s Office is aggressively prosecuting corrupt doctors and medical professionals who unlawfully distribute painkillers and other prescription narcotics," stated U.S. Attorney Brady. "If you are a doctor who is exploiting your patients’ addiction to feed your greed, you are hereby on notice: first we will take away your livelihood and then we will take away your liberty."
"These were trusted health care professionals. They had an obligation to prescribe an appropriate amount of opioid medications and only what was necessary," said Acting Special Agent in Charge Chad Yarbrough. "Instead, they betrayed that trust and contributed to the growing opioid epidemic. The FBI wants to make it clear: dishonest medical professionals will be held accountable for their crimes."
According to U.S. Attorney Brady, the following five cases were part of the national health care fraud takedown:
1. United States v. Peter James Ridella: Dr. Peter James Ridella was charged with one count of conspiracy to unlawfully dispense and distribute oxycodone and Percocet and one count of health care fraud. Ridella conspired to create and submit unlawful prescriptions for oxycodone and Percocet, and then unlawfully dispensed over 24,000 mg of controlled substances to other persons. Ridella is also charged with health care fraud for allegedly submitting fraudulent claims to Highmark, for payments to cover the costs of the unlawfully prescribed oxycodone and Percocet.
2. United States v. Michael Cash: Dr. Michael Cash was charged with one count of unlawfully dispensing and distributing a Schedule III controlled substance, one count of conspiracy to unlawfully dispense and distribute Schedule III controlled substances, and one count of health care fraud. Cash conspired to create and submit unlawful prescriptions for buprenorphine, known as Subutex and Suboxone, and then unlawfully dispensed 32,000 doses of buprenorphine to other persons. Cash is also charged with health care fraud for allegedly submitting fraudulent claims to Medicare, for payments to cover the costs of the unlawfully prescribed buprenorphine.
3. United States v. Ruth Jones: Dr, Ruth Jones was charged with one count of unlawfully dispensing and distributing a Schedule III controlled substance, one count of conspiracy to unlawfully dispense and distribute Schedule III controlled substances, and one count of health care fraud. Jones conspired to create and submit unlawful prescriptions for buprenorphine, and then unlawfully dispensed 22,382 doses of buprenorphine to other persons. Jones is also charged with health care fraud for allegedly submitting fraudulent claims to Medicare, for payments to cover the costs of the unlawfully prescribed buprenorphine. Dr. Jones is scheduled to plead guilty on Friday, June 29, 2018, at 10:30 a.m.
4. United States v. Christopher Handa: Suboxone clinic operations manager Christopher Handa pleaded guilty today, June 28, 2018, to two counts of unlawfully dispensing and distributing a Schedule III controlled substance, one count of conspiracy to unlawfully dispense and distribute Schedule III controlled substances, and one count of health care fraud. Handa was employed by Redirections Treatment Advocates, a Suboxone clinic located in Washington, Pennsylvania. Handa and others conspired together to create and submit unlawful prescriptions for buprenorphine, and then unlawfully dispensed 18,146 doses of buprenorphine to other persons. Handa also committed health care fraud by causing fraudulent claims to be submitted to Medicaid for payments to cover the costs of the unlawfully prescribed buprenorphine.
5. United States v. Omar Almusa: Dr. Omar Almusa pleaded guilty yesterday, June 27, 2018, to one count of unlawfully dispensing and distributing Schedule II controlled substances, one count of conspiracy to unlawfully distribute Schedule II controlled substances, and one count of health care fraud. Almusa conspired to create and submit unlawful prescriptions for Vicodin, and then unlawfully dispensed 39,600 mg of Vicodin to other persons. Almusa also committed health care fraud by submitting fraudulent claims to UPMC Health Plan, for payments to cover the costs of the unlawfully prescribed Vicodin.
These cases are being prosecuted by Assistant U.S. Attorney Robert S. Cessar.
Since Attorney General Sessions announced the formation of Opioid Fraud and Abuse Detection Units throughout the country in August 2017, the Western Pennsylvania
OFADU has been one of the national leaders in attacking opioid diversion by medical professionals. Following its formation, the Western Pennsylvania OFADU filed the first indictment against a doctor in the nation, and has filed charges against 15 doctors and medical professionals. Further, a total of ten DEA Registrations, which allow doctors to prescribe controlled substances, and seven doctors’ licenses to prescribe Medication Assisted Treatment have been surrendered; and five medical licenses have been suspended by the Pennsylvania Department of State.
The investigations leading to the filing of charges in these cases were conducted by the Western Pennsylvania Opioid Fraud and Abuse Detection Unit, which combines personnel and resources from the following agencies to combat the growing prescription opioid epidemic: Federal Bureau of Investigation, U.S. Health and Human Services – Office of Inspector General, Drug Enforcement Administration, Internal Revenue Service-Criminal Investigations, Pennsylvania Office of Attorney General - Medicaid Fraud Control Unit, United States Postal Inspection Service, U.S. Attorney’s Office – Criminal Division, Civil Division and Asset Forfeiture Unit, Department of Veterans Affairs-Office of Inspector General, Food and Drug Administration-Office of Criminal Investigations and the Pennsylvania Bureau of Licensing.
Today’s national enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units.
A complaint, Information, or Indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. The filing of an Information generally indicates that the defendant intends to enter a guilty plea.