
Six Detroit area doctors indicted in $500M health care fraud - bubmiw
http://www.fox2detroit.com/news/local-news/six-detroit-area-doctors-indicted-in-500m-health-care-fraud
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pupdogg
Wow! Now it makes sense how Dr. Rajendra Bothra was well connected in the
Indian Bollywood industry. I personally recall big Bollywood stars opting to
stay over his house during their US trip instead of a local 5 star
hotel...mind you, this was back in late 90s. I hadn't heard of him in a while
thinking he might've retired or died. This is a shocker that they're taking
him down while in his retirement. Feds do not kid around!

~~~
newyankee
It is well known that a lot of Bollywood was bankrolled by the Indian
underworld in the 90s. This used to be much more common before the recent
(last 10-15 years) which led to more corporate like setups. I am assuming a
lot of the underworld folks slowly cleaned some of the stuff. But also very
well known that the industry is very incestuous and dynasty oriented at least
as far as many actors are concerned. Not the least surprised.

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mindslight
> _" The damage that opioid distribution has done to our community and to the
> United States as a whole has been devastating" said U.S. Attorney Schneider_

I guess scapegoat big pharma is successfully finding their own scapegoats!

The feds could straightforwardly address the fentanyl problem by
deillegalizing opiods, allowing reputable distribution to take over. And then
society could maturely deal with addiction as a personal medical problem. But
I guess it's easier to keep hanging it all on personal responsibility and let
that DEA/CIA gravy train continue rolling.

~~~
hn_throwaway_99
> The feds could straightforwardly address the fentanyl problem by
> deillegalizing opiods, allowing reputable distribution to take over. And
> then society could maturely deal with addiction as a personal medical
> problem.

I don't understand this at all. Most opioids _are_ legal prescription drugs.
The problem is that they are highly addictive, so despite trying deal with
addition as a "personal medical problem", which is how many opioid addicts are
treated in the US, it still results in a huge increase in dead people.

~~~
thaumasiotes
>> The feds could straightforwardly address the fentanyl problem by
deillegalizing opiods, allowing reputable distribution to take over.

> I don't understand this at all. Most opioids _are_ legal prescription drugs.

It's pretty straightforward. "Legal prescription drugs" are drugs you're not
allowed to have without permission, and doctors face prosecution for giving
you permission. This doesn't really promote safe availability -- it's
specifically intended to do the opposite.

~~~
hn_throwaway_99
Yeah, surely the solution to the opioid epidemic is making fentanyl available
at CVS.

~~~
mindslight
The current approach doesn't seem to have constrained availability much, so
that is baseless hyperbole.

The point is that opiates from a reputable distribution channel wouldn't be
laced with fentanyl. Have the state run the stores, appropriate security on
duty, set the price just below market level, and use the profits to fund
treatment programs. Tie the treatment programs into the retail stores, for
immediate feedback for when people deviate. The treatment programs could even
do things like accept returns for full refund, so people who are trying to
quit aren't tempted to keep a stash laying around.

I doubt most people addicted to opiates actually want to be addicted - an
aspect that gets left out of the righteous narrative.

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koolba
> Officials said the defendants prescribed opioid medications to induce
> patients to visit the office, then in order to get them, they had to undergo
> ancillary services, including painful facet joint and facet block
> injections.

This is disgusting on so many levels.

If this is true I hope they throw the book at all of them and anyone else
involved as well.

~~~
barking
The doc who's 77 has lived his life and enjoyed the fruits of his crimes. No
matter happens now he'll finish ahead.

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CaliforniaKarl
Ugh. I’m going on for surgery next Thursday, for a laparoscopic partial colon
resection, and one of the things I’m most worried about will be post-surgery
pain killers. Hearing stories about excessive pain killer use and prescription
really make me want to avoid them, but on the other hand I’ll need to be up &
moving around ASAP to speed my recovery, and pain would get in the way of
that.

~~~
akamel
Use them only when you need them.

I was really annoyed when my wife’s doctor freely prescribed her oxi after her
delivery even though my wife never asked for it and never showed any sign of
needing it.

Having free flowing prescriptions is how we end up with so many addicts.

~~~
mgkimsal
and then... for legitimate cases... no dice.

about 7 years ago my wife got sand in her eye - was problematic enough that we
went to a local clinic. she wasn't going to go blind, but it was irritated
enough that after flushing it out, it still looked... bad. and she indicated
it was a bit sore, that she wanted to get home to just try to get to sleep.

The doctor there offered a prescription for percocet. We said "no, no need -
we'll call if there's a problem". They handed us a prescription for... either
7 or 14 pills. we took it and didn't use it.

A few years later I ended up with extreme lower back pain. I could hardly move
- was bed/chair-bound for 4 days. Had called around to see if any clinic would
see me to prescribe some pain killer. NOPE. Don't want to create any addicts.
Clinics all have signs on them saying 'no prescriptions for...' then a list of
4-5 things.

We were basically force-fed a prescription for something way out of line with
what was necessary, then when something _was_ necessary... not available.

Yep, just my anecdote, but it's stuck with me, mostly because I don't have
that many medical interactions in the first place, so the outliers tend to
stick out.

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lostlogin
I know that you have likely shortened the story for reading, making the phone
call sound different to how it really went, but if you want to set off alarm
bells, ringing around asking about a script for strong pain meds is a way to
do it.

~~~
mgkimsal
when you're in intense pain, it's difficult to drive around to too many places
(wife drove me to one), she called a few others, no one would even agree to
schedule me to come in for a consultation/exam.

one office offered to schedule an appointment for about 4 weeks later, which I
didn't take.

This situation has happened to me twice, both times this pain came out of
nowhere, and first time it took me out of commission the better part of 4
days. Tried to get any medication (per above story) - nothing. Second time
this happened, 2 years later, it lasted about 3 days, and I didn't even bother
trying to get anything - just took a lot of OTC stuff. If this happened
regularly, I might be able to figure out if there's some trigger to avoid,
but... 2x in the last 6 years - hard to pinpoint!

I should add that this gave me a little bit of insight as to how people who
live with chronic pain might feel all the time. Just a few days of that was
maddening. Thinking it might be the 'new normal' \- constant intense pain that
rarely lapses - would really have been difficult to cope with, and I probably
can emphathize (or is it sympathize?) a bit more with the prescription drug
abuse situation.

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danans
If true, $500M of fraud (over only 5 years!) is hard to fathom considering it
is a small clinic. I'm wondering how it wasn't discovered before it got to
this level. You'd think that even $100M would have set off alarms somewhere.

~~~
HillaryBriss
interesting that only about $10 million was fraudulently billed to a private
company (blue cross/blue shield), and pretty much all the rest was billed to
state and federal governments.

maybe this is reading too much into it, but might this be evidence that
government health care funds are poorly managed and pay out too much, too
often, asking too few questions in the process?

~~~
CPLX
Or it’s evidence that they exploited a population that doesn’t have private
health insurance.

~~~
HillaryBriss
yeah, that seems reasonable. and maybe the patient population in their area is
covered almost exclusively by state and federal plans because of low income.

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whalesalad
Bloomfield Hills and Birmingham... doesn't surprise me. This isn't really fair
to associate with Detroit either. These are suburbs 30+ minutes outside of the
city.

~~~
rmason
Seems like it's unique to Detroit. I've tried for thirty years to get software
companies to extend their road trips to Detroit. But I get told there's only
670,000 people there and that's way too small. Then I inform them there's
4.5-5 million people in the Detroit metro area. So now this is the reverse,
instead of saying North of Detroit they tar and feather Detroit in the story.

One of the Doctors mentioned is in Ada which is near Grand Rapids and clear
across the state!

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127001brewer
It's been years since I have worked in this space, but, at the time, my group
was charged with finding fraud committed by the providers and beneficiaries.

It was interesting work: we had data tapes shipped from CMS to us, we loaded
the data into a Sybase database, and then used an analysis tool (which I can't
recall the name of) to look for patterns of fraud - again, this was what now
seems like a lifetime ago.

Is anyone currently working detecting Medicare and Medicaid fraud?

~~~
127001brewer
One of the interesting things I there while there was develop a Java app and
Python script to semi-automate the loading of tapes. ​ ​Previously, a person
had to load a few tapes into a magazine, place it into a machine, and manually
load each tape - they had to sit in a secure room, wait for a tape to be
loaded, and press a button to for the machine to load the next tape! ​ ​Since
this tape machine was old, there wasn't a lot of documentation, but I did find
enough information to develop a script that loaded each tape, placed the data
in the correct directory based on the tape's header information, and then
emailed the data team once all the tapes in the magazine were loaded. It freed
up that person to do meaningful work while the data tapes were being loaded.

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ghufran_syed
I'm a little confused - so if the docs "just gives narcotics without
considering alternatives", then that's supposed to be WRONG and encouraging
addiction. But if the doc feels other potentially beneficial treatments such
as facet joint injections should be tried first, then they are accused of
coercing the patient into an unnecessary procedure, essentially bribing then
with narcotics. Damned if you do and damned if you don't...

~~~
ensignavenger
This is exactly what the new article makes it sound like. I can only hope the
feds have some hard evidence to back up their fraud claims and this isn't just
a "see, we are doing something! Vote for us!" tactic. If the Feds allow the
defendants to hire representation, I guess a jury will decide.

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mdgrech23
As a Detroiter I'm not surprised in the least bit. It seems yearly that some
a'hole doctor is in the news for doing something terrible.

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55555
> It is alleged that between 2013-2018, the following doctors engaged in
> illegally prescribing controlled substances and fraudulent health care
> billings:

This breaks the rule about not breaking the law while breaking the law.

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kennxfl
If anyone read Confessions of an Rx Drug Pusher, it's pretty easy to see why
most doctors will never advise against pain killers. The incentive to write
more prescriptions is just too high. Also fentanyl is super scary

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mindfulplay
It took this long :( it's scary how long it takes to prosecute! I am sure the
lobby determines some of this latency ..

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vondur
Wow,that’s a huge amount of fraud. If they get convicted they may never see
the outside of a prison again.

