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Healthcare CEO, physicians indicted in $200 million Medicare fraud involving opioid doses, harmful injections

Alleged scheme preyed on Medicare beneficiaries, some of whom were addicted to opioids, creating shell companies and getting millions in kickbacks.

Beth Jones Sanborn, Managing Editor

A CEO and four physicians from Michigan and Ohio have been charged with an array of criminal counts including conspiracy to commit healthcare fraud, healthcare fraud, paying and receiving kickbacks and money laundering in connection to a massive $200 million fraud scheme involving a network of Michigan and Ohio pain clinics, laboratories and other medical providers.  

The indictment also contains allegations regarding the distribution of over 4.2 million medically unnecessary opioid doses and medically unnecessary injections resulting in patient harm, according to the Department of Justice.   

Mashiyat Rashid of West Bloomfield, Michigan; Spilios Pappas of Monclova, Ohio; Joseph Betro of Novi, Michigan; Tariq Omar of West Bloomfield, Michigan; and Mohammed Zahoor also of Novi, were each charged with one count of conspiracy to commit healthcare fraud and wire fraud. Rashid was additionally charged with healthcare fraud, conspiracy to defraud the United States and pay and receive healthcare kickbacks, payment of kickbacks, receipt of kickbacks and money laundering. Pappas, Betro, Omar, and Zahoor were each also charged with healthcare fraud.  

According to the DOJ which cited an indictment, Rashid was the CEO of Tri-County Wellness and owned, controlled and operated numerous pain clinics, laboratories and other providers in Michigan and Ohio. From 2008 until their arrests in 2017, Rashid, Pappas, Betro, Omar, Zahoor and other physicians working in Rashid's clinics allegedly conspired to attract patients by prescribing more than 4.2 million doses of medically unnecessary controlled substances, including oxycodone, hydrocodone and oxymorphone to Medicare beneficiaries. 

Some of the beneficiaries were addicted to narcotics and some of the opioids allegedly were resold on the street, according to the DOJ.

There are additional allegations that Rashid and his co-conspirators demanded that Medicare beneficiaries looking for controlled substances submit to expensive, medically unnecessary and painful injections. Rashid paid his alleged co-conspirators and other physicians based on the number of injections that Medicare paid for, the DOJ said.

When Medicare reviewed the injection claims, it ruled that none of the claims were eligible for Medicare reimbursement and suspended the medical billing privileges of one of the pain clinics involved in the alleged scheme. The defendants then created new shell companies that they enrolled in Medicare to continue the operation. 

According to the DOJ, Rashid also owned a diagnostic laboratory where medically unnecessary urine drug testing was conducted. Upon a review by Medicare, 95 percent of the claims filed from that facility were deemed ineligible for reimbursement and ordered the lab to repay more than $6.9 million to Medicare, court documents submitted in connection with Rashid's detention hearing show. Once again, the indictment said Rashid and the other defendants created a new shell company and enrolled it in Medicare to continue the alleged operation.

Rashid is accused of paying illegal kickbacks to obtain patients and solicited illegal kickbacks for other defendants to refer Medicare beneficiaries to certain third-party home health agencies, laboratories and diagnostic providers even though those referrals were medically unnecessary. 

Rashid was also charged with money laundering in connection with a $6.6 million wire transfer in April of 2016 and a $500,000 cash withdrawal in July 2017. The indictment said Rashid used the money to finance a lavish lifestyle that included luxury clothes, exotic automobiles such as a Lamborghini and Rolls Royce Ghost; a mansion and other real estate in the Detroit, Michigan area; and VIP seating at NBA basketball games, including the NBA Finals.  

"It is a sad day when a physician allows greed to drive their moral compass and willfully violate their Hippocratic Oath to protect and treat their patients," said IRS Criminal Investigator Chief Don Fort. "The conduct described in this indictment, particularly the 4.2 million medically unnecessary dosages and administered injections, provides alarming insight into the growing opioid epidemic our nation is facing…"

As certain physicians and healthcare leaders pour fuel on the fire of the opioid abuse epidemic currently ravaging the United States, both the CDC and state and local governments are pouring money into finding interventions and curtailing the devastating tide of overdose deaths. New Hampshire hospitals will fund abuse interventions using $50 million of their own money over the next five years and the CDC has committed millions as well. Hospitals and providers are looking for ways to change prescribing protocols so that they are doling out fewer opioid doses for pain issues and researchers are diving in as well, with one recent study showing that certain methods of administering opioid pain medications, specifically oral and injection methods, are potentially less addictive than IV administration.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

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