Medicare Compliance & Reimbursement

Warning: Latest round of settlements target physicians.

As the nation continues to grapple with COVID-19, opioid abuse and prescription drug fraud are running amok — and the authorities are beefing up their enforcement efforts. In fact, five September cases suggest that physicians are getting the brunt of the feds’ ire.

In Connecticut: Shelton-based physician David Ciancimino was arrested in a cash-for-drugs scheme that ran from July 2020 to September 2021, a Department of Justice (DOJ) release indicates. In a takedown that utilized undercover federal task force agents, an investigation “revealed that Ciancimino was providing prescriptions for Adderall or Xanax to numerous individuals in exchange for $200 in cash, typically with little to no medical examination of his patients,” DOJ notes. Another issue: While Ciancimino was pocketing the cash, Medicaid was charged for his patients’ prescriptions.

Ciancimino not only deposited upwards of $365,000 into his bank account, but also accepted dozens of Venmo payments, too. Charges include false statements, healthcare fraud, and distribution of controlled substances; “Ciancimino appeared before U.S. Magistrate Judge Robert M. Spector and was released on a $500,000 bond,” and is awaiting trial, the DOJ brief indicates.

In Virginia: Dr. Leonard Rosen may see jail time for an elaborate prescription scheme with pharmacist Mohamed Abdalla. The Alexandria-based OB-GYN agreed to “prescribe expensive compounded pain and scar creams” in an insurance scam facilitated through Abdalla’s pharmacies, DOJ expounds in a release. Rosen was slated to share in the profits from the medically unnecessary claims through his arrangement with the pharmacist.

With prescription losses exceeding more than $1.8 million, Rosen could face up to 10 years in prison for his part in the scheme. He’s scheduled to be sentenced on Dec. 10, DOJ says.

In Michigan: One Wayne County physician could get life in prison for his part in “administering medically unnecessary spinal injections in exchange for prescriptions of high doses of opioids to patients” and defrauding Medicare, a DOJ release warns. Patients of Francisco Patino, a pain doctor in Livonia, would receive opioids in exchange for agreeing to get — or be billed for — medically unnecessary facet joint or nerve block injections. The doctor, also, punished patients who refused his scheme by withholding the opioids, DOJ says.

In addition to the opioid fraud, Patino received kickbacks from a diagnostic lab and used his fraud proceeds to promote his diet and lifestyle book. “Patino paid Ultimate Fighting Championship and other mixed martial arts fighters to promote the Patino Diet,” DOJ mentions.

In Georgia: The U.S. District Court for the Southern District of Georgia brought a 52-count federal indictment against three individuals — including Wallace Steven Anderson, a physician in Douglas — for opioid fraud. One of the charges against Anderson includes the distribution and dispensation of controlled substances that resulted in the death of an individual, a DOJ release suggests.

Between February 2016 and September 2020, Anderson and his employees, nurse practitioner Bridgett Stephanie Taylor and physician assistant Wandle Keith Butler, allegedly “operated or assisted in operating ‘nominal pain management and addiction facilities which dispensed controlled substances without any legitimate medical purpose,’” according to the indictment.

A trial has not been set yet for the defendants, but DOJ reminds that all are presumed innocent until proven guilty.

In Louisiana: New Orleans-based physician Adrian Dexter Talbot was charged in a grand jury indictment “for his role in distributing over 1,200,000 doses of Schedule II controlled substances, including oxycodone and morphine, outside the scope of professional practice and not for a legitimate medical purpose, and for maintaining his clinic for the purpose of illegally distributing controlled substances,” a DOJ release indicates.

The indictment also alleged that Talbot defrauded Medicare and other insurers with his opioid prescriptions that totaled more than $5.1 million and were paid with insurance benefits, DOJ says. Talbot had his first court appearance on Sept. 10; a federal judge will determine sentencing.