PHILADELPHIA – United States Attorney William M. McSwain joined fellow Justice Department officials at a press conference to announce a coordinated health care fraud enforcement action across seven federal districts involving more than $800 million in loss and the distribution of over 3.25 million opioid pills in “pill mill” clinics, according to a press release from U.S. Attorney’s Office in Eastern District of Pennsylvania.
The takedown includes new charges against 48 defendants for their roles in submitting over $160 million in fraudulent claims. Of those 48 defendants, 15 are doctors or medical professionals, and at least 24 defendants were charged for their roles in diverting opioids. In the Eastern District of Pennsylvania, 17 defendants (five of whom are doctors or medical professionals) were arrested, and the conduct involved submission of more than $4 million in fraudulent claims and distribution of approximately 738,000 oxycodone pills to the streets of this District.
In addition to many others, the case involves defendants Neil K. Anand, M.D., 42, of Bensalem, PA, and Asif Kundi, 31, Atif Mahmood Malik, 34, and Viktoriya Makarova, 33, all of Philadelphia, PA. Anand, a medical doctor, Kundi and Malik, unlicensed foreign medical school graduates, and Makarova, a nurse practitioner, were each indicted on one count of health care fraud and one count of conspiracy to distribute controlled substances.
The charges stem from the defendants’ alleged submission of false and fraudulent claims to Medicare, health plans provided by the United States Office of Personnel Management (OPM), and Independence Blue Cross (IBC). The claims allegedly were for “Goody Bags,” which were stuffed with medically unnecessary prescription medications that were dispensed by non-pharmacy dispensing sites owned by Anand. In total, Medicare, OPM, and IBC allegedly paid over $4 million for the Goody Bags. Patients were allegedly required to take the Goody Bags in order to receive prescriptions for controlled substances.
According to the indictment, Malik and Kundi wrote prescriptions for controlled substances using blank prescriptions that were pre-signed by Anand or Makarova. Anand and Makarova provided over 10,000 prescriptions for Schedule II controlled substances, of which over 7,000 were for oxycodone, for a staggering total of over 634,000 oxycodone tablets distributed from this scheme. The investigation was conducted by the following agencies: FBI, Department of Health and Human Services – Office of Inspector General (HHS-OIG), United States Postal Service – Office of Inspector General (USPS-OIG), the Office of Personnel Management, the Pennsylvania Office of Attorney General, and the Philadelphia Police Department. The case is being prosecuted by DOJ Trial Attorney Jaroslawicz.
“Physicians and other medical professionals who fraudulently bill our federal health care programs are stealing from taxpayers and robbing vulnerable patients of necessary medical care. The medical professionals and others engaging in criminal behavior by peddling opioids for profit continue to fuel our nation’s drug crisis,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The Department of Justice will continue to use every tool at our disposal, including data analytics and traditional law enforcement techniques, to investigate, prosecute, and punish this reprehensible behavior and protect federal programs from abuse.”
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.