Case: In February 2019, the physician/medical director of a pair of sober home clinics in clinics was sentenced to 11 years in prison and ordered to pay $1 million in restitution for his role in a massive fraud scheme involving billings for millions of dollars of unnecessary urine drug tests on recovering addicts. I was just a patsy in the 20-member conspiracy, the physician had claimed. But after an eight-day trial, the Florida federal jury found him guilty of conspiracy to commit health care fraud and distribute controlled substances, as well as seven counts of unlawfully dispensing controlled substances. The owner of the clinics who served as ringleader of the scheme is also serving a 27-year sentence after being convicted of multiple charges. Significance: The U.S. Court of Appeals for the 11th Circuit ruled that there was more than enough evidence to support the verdict and sentence and tossed the appeal. The physician played a central role in the scam. It wasn’t just that he ordered all of the tests but also the way he ordered them. For one lab, he issued a standing order authorizing as medically necessary 2 to 3 scheduled and up to 2 random tests on […]
Case: In February 2019, the physician/medical director of a pair of sober home clinics in clinics was sentenced to 11 years in prison and ordered to pay $1 million in restitution for his role in a massive fraud scheme involving billings for millions of dollars of unnecessary urine drug tests on recovering addicts. I was just a patsy in the 20-member conspiracy, the physician had claimed. But after an eight-day trial, the Florida federal jury found him guilty of conspiracy to commit health care fraud and distribute controlled substances, as well as seven counts of unlawfully dispensing controlled substances. The owner of the clinics who served as ringleader of the scheme is also serving a 27-year sentence after being convicted of multiple charges.
Significance: The U.S. Court of Appeals for the 11th Circuit ruled that there was more than enough evidence to support the verdict and sentence and tossed the appeal. The physician played a central role in the scam. It wasn’t just that he ordered all of the tests but also the way he ordered them. For one lab, he issued a standing order authorizing as medically necessary 2 to 3 scheduled and up to 2 random tests on a single patient per week. For the second lab, he pre-signed blank requisition forms for drug tests leaving the patient information blank so that others could enter it later. In each case, staff photocopied the documents and used them to maximum advantage, often ordering tests and providing their own urine samples for patients who didn’t show up for appointments [U.S. v. Abovyan, 2021 U.S. App. LEXIS 5030, 988 F.3d 1288, 28 Fla. L. Weekly Fed. C 2452].
