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Six Detroit area doctors indicted in $500M health care fraud (fox2detroit.com)
128 points by bubmiw 3 months ago | hide | past | web | favorite | 77 comments

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!

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.

That's what you get for making millions of dollars by taking advantage of people's trust and ruining their lives.

> "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.

It's crazy that cannabis is a schedule 1 drug. It's by far the safe way to manage chronic pain but federally illegal. I'm glad the states have the chutzpah to make it legal. The older I get the more I see how this country is run on money above everything else.

Crazier still is that kratom is getting lined up to be scheduled as well, when it is a proven safe tool for weaning people off of opiates.

Kratom is great as medicine to wean people off opiates.

However, it absolutely shouldn't be used in a recreational setting as it currently is, served in kratom bars (though they like to use the name "Kava" in an attempt to fly under the radar).

See /r/quittingkratom

Why would they sell it as Kava when Kratom is more expensive? I am on day 5 of getting off of Kratom. This smy second time around, and the first was horrendous. A couple of months ago a doctor prescribed Gabapentin and I've literally experience only 5% of the side effects of withdrawal. All the intense symptoms disappeared and I glided through this week. I wonder why doctors prescribe Suboxone and Methadone, both highly addictive.

Kava actually costs more than kratom.

But I never said people sell kava as kratom. Selling Kratom in bars is against the law. Instead they set up “kava” bars in which they sell kratom and kava.

Any arguments like this that don't also call for banning alcohol and tobacco are specious at best.

Society has "agreed" that while those substances are dangerous, it is up to the individual to determine how they are consumed.

So this then becomes an argument of "I don't like your vice and I'm going to decide whether or not you can partake".

> Society has "agreed" that while those substances are dangerous, it is up to the individual to determine how they are consumed.

Unless you're under a certan age, or driving a car, or piloting a plane the next day, or etc etc.

And there is strong societal pressure against pregnant women drinking any alcohol at all despite there being no evidence that small amounts of alcohol are harmful during pregnancy.

Ok. I'm over 21, not pregnant and not operating a vehicle under the influence.

What's your point?

My point is that society has not said you can do what you like with alcohol, and should not do so for opioids, and that the restrictions for opioids are going to be stronger than the restrictions for alcohol even if opioids become freely and legally available to all who need them.

True that I didn’t call for alcohol to be banned. Are you arguing that opioids should be served recreationally in bars?

At some point we need to draw a line.

I'm arguing against making drugs illegal to "protect" people.

I use kratom both for pain management and at times to take the edge off. That would be "recreational" at that point. I don't want you to be my nanny.

> Are you arguing that opioids should be served recreationally in bars

Maybe, actually. When my brother died of a heroin overdose it was ultimately his mistake but the "market" failed him because there were no standards for purity or strength.

Bear this in mind: heroin is illegal. My brother is dead. What protection was offered there? The cops laughed at another dead junkie.

Do you drink alcohol? Are you fat? Do you ride a bike without a helmet? Smoke cigars? Do rock climbing? Ride motorcycles? Skydive? etc. etc. etc. If so, you must now stop. I'll let you know what you can there going forward, thank you very much.

Are you aware of the history of drug prohibition in the fact that it had absolutely nothing to do with preventing self harm but was an excuse for using the laws for oppressing the underclass.

I know you are arguing in good faith with good intentions but you are horribly, dangerously wrong.

I'm sorry about your brother, but had there been no heroin to consume, he would never have been in a position to make the "ultimate mistake", as you put it.

People are stupid, kids are dumb, people are in great pain and want oblivion, people are bored, people just want to have a good time. There are numerous reasons people abuse drugs.

The greater the access to drugs, the greater the potential damage to drug consumers and people around them.

> I'm arguing against making drugs illegal to "protect" people.

Contrary to your comment on society not deeming alcohol worth banning, we actually ban those things in most situations due to the damage they do. We do that to protect people. Riding a bike without a helmet is against the law where I live, thankfully.

I like that there are laws that restrict what I, a grown man, can do. I don't think there's an inherent need to have the freedom to do anything I want. I can't shoot a man in the head, I can't rape and pillage, I can't take some drugs that science has proven that many humans don't have the capacity to safely consume on a recreational basis.

"It's my body and I'll do what I want with it. You're not my mom!!" isn't something I'd ever say. I live in a community. I have a family and friends.

We'll have to agree to disagree.

> we actually ban those things in most situations due to the damage they do

We can disagree on personal liberties but not on history. The history of drug prohibition is rife with the oppression of minorities. Here's something to consider: http://www.drugpolicy.org/issues/race-and-drug-war

> "It's my body and I'll do what I want with it. You're not my mom!!"

That's really patronizing and doesn't help your argument at all.

It's clear your mind is made up so I won't push the issue, but while you are well-intended you appear to be rather naive about this subject.

Being that your attitude helps prop up this madness and actually contributes to more misery, I can't help but strongly resent your nanny-state inclinations.

It will be interesting to see if they finally make kratom schedule 1. When they tried it last time, the public outcry was enough to stop it.

And I agree it would be awful if they did. Kratom is certainly not without addiction risk, but if you believe in harm reduction, it’s far better to have people taking it versus prescription opioids or heroin.

Apparently the current FDA head has financial interests in doing the wrong thing: https://www.reddit.com/r/kratom/comments/7et2l8/fda_loyalty_...

disclaimer: yes, it's a reddit post but it seems to capture the essence of the situation and I'm too lazy for other citations at the moment.

> 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.

>> 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.

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

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.

It comes down to the question of whether you think the opioid epidemic is mostly bad because even perfectly safe addiction stops people from living fulfilling / valuable / productive lives, or if it is mostly bad because people are dying from their addiction.

Making fentanyl available at CVS would probably increase the number of people addicted to opioids, but would also vastly reduce the risk of death in those people (due to better quality control and consistent dosage).

Personal medical problem would be treated by a doctor - ie. methadone, etc. Instead it is treated as a personal vice problem - ie. dealers/LEO instead of doctors.

They regularly give Fentanyl to pregnant women during labor. We know some of it crosses the placenta and enters the baby. Does anyone know why this is OK?

The problem with Fentanyl is dosage. It's really concentrated so if the manufacturing or separation into portions isn't well controlled then it's easy to end up with a much higher dose than expected. In a hospital with a known reliable source, you can get the right dose. When it's been cut into fake pain pills, it's easy to overdose.

> 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.

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

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.

I work as a nurse on a general surgery floor- exactly where you'll be after you leave the PACU. Your procedure is planned laparoscopic, which will considerably lessen your pain and recovery time. I've had several patients in your situation not take any opiates at all. Ask your physicians to consider a regimen of scheduled ketorolac or ibuprofen, acetaminophen, and gabapentin. Any opiates will be prescribed PRN (as needed), and generally will only be offered if you ask for them. As you alluded to, your safest bet pain-wise is to get the non-opiates on board first and only take opiates as required to facilitate your getting up and walking around- an essential part of your recovery.

As a disclaimer, you may have poor liver or kidney function which would contraindicate some of the medications I mentioned, your surgical team will make that call.

Sorry to be late catching this, I hope you come across it! It's awesome that there's a nurse reading HN! Thanks much for all of the info, I've never heard of ketorolac or gabapentin before. I know there's no way to know exactly what'll happen until the day, but it's good to hear from the "boots on the ground" that this is not at all unusual.

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.

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.

Asking for a prescription for a painkiller will make doctors label you as a drug seeker.

Asking for a referral for an x-ray/ultrasound for your back pain will often make them go "Here, why don't you try this opioid first and see if it gets better?"

The key phrase here is "a few years later". Much has changed in this area of medicine over the last few years...

I'm sorry for your pain. Back problems are the worst.

Oversteer is the norm. Precautionary principle and all that.

Patients with chronic pain have to train their care givers, just as they have to train you. You're building relationships, trust. Just like dating, jobs. Unhappy or uncomfortable? Move on to others you can work with.

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.

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.

I second this. I did this for my surgeries. If I took meds at all, I took them only early when likely pain was highest on in minimal, prescribed dose. Then as little as I could from that moment forward just enduring the discomfort, being careful about how I moved, etc. I got over it. Sometimes, the pain was low enough for OTC drugs should I have wanted to use them.

Good way to avoid getting addicted.

I third this. Vicodiene when you need it is a lifesaver after surgery, but it can tempting to continue with it beyond when you need it. Just beware and stop.

I did something similar when I broke my ribs. I was prescribed Vicodin and Ibuprofen. I’d only take the minimum amount of Vicodin twice a week, and the other days would use Ibuprofen only. I also made sure I never took more than the minimum required dose two days in a row.

Yeah, I remember when I got a wisdom tooth out, afterwards I got a prescription for something pretty strong. Vicodin, I think? It was years ago, and I don't remember.

But I do remember that, even though I filled the prescription, I never ended up taking it. A few days of higher-dose ibuprofen (taken with food) was enough.

I got a prescription for hydrocodone after having a wisdom tooth taken out. I never bought it, and I didn't take any other medication either. There was mild discomfort for 12 to 18 hours, but it's crazy they're prescribing pain meds by default for no reason. And there was no instruction from the doctor to limit the pain med to only if absolutely necessary.

Better to have a 3 day supply on hand just in case vs the mad scramble to get scripts filled afterwards.

Having post-operative pain is a legitimate reason to use them. Just use them judiciously. Your goal should not be a pain level of zero, it should be a pain level that is manageable. You will likely have the option of using Tylenol instead if you prefer, and possibly NSAIDs, so you can try either of those before you resort to narcotics. Everyone reacts different. In the past week I've had someone who underwent a hip replacement who can't get around without heavier doses of narcotic pain meds. And I've had a guy who had his leg amputated, who just takes Tylenol.

What I understand is that addiction usually starts from misuse and overprescription. If you are given pain killers for acute pain or recovery from surgery the rates of abuse are lower.

There's some research showing that acetaminophen + ibuprofen can be as good or better than Opioids for pain relief, though I don't know that it applies to post-surgical pain.



The person who knows their need for pain control best is you.

Follow your doctor’s recommendations and communicate how the pain is.

Some people need opioids for relatively minor surgery while others can get by with NSAIDS for relatively major surgery.

I have family that was on opium based pain killers after surgery. Their description was to the effect of, "that is some goood shit". Upon recovery, they stopped taking it. I suppose they no longer had holes in their life that needed filling with a pain killer, literally and figuratively, and knowing that made it easier to not become dependent.

Probably depends on the person, some might get addicted after a cigarette, others not even after 10 packs. But that person might get addicted to alcohol.

Either way, after an operation might as well suck it up a bit, like they did before Oxy and the likes came.

If you've done other drugs before and you're currently ok, then you should be fine. If you've never done drugs before, then just remember that you're taking these drugs for a reason, and once that reason is gone, then you don't need the drugs anymore.

Recreational drug use can be fun but I don't think that's your prerogative here.

Have you asked about other options? Alternating acetaminophen & ibuprofen has been popular among the docs I've seen recently. Heck, around here many get a bottle of 800mg ibuprofen after a C-section, no opiods.

Ibuprofen might probably be ruled out, due to the stomach upset it can cause in larger doses, and they may not want the anti-inflammatory effect(?). But yeah, acetaminophen would work!

Maybe you can make sure to discuss this with your doctor until you feel comfortable?

Yup! It's one of two things I'll bring up in the pre-op meeting with the surgeon:

1. Make sure we're in agreement as to the things being done. Yes, it's been discussed multiple times, but best to be clear!

2. Ask what kind of pain killers I'll already be on when I wake up.

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.

I recall a few years back on some radio show probably OPB they just started recently to aggregate and chart all of the billing codes from every doctor in the nation, specifically related to medicare billing. It was at that point that they just started to find fraud. So this is a new thing that they can do, and I guess this is one of the outcomes.

I can't wait for them to do this to the military black budget one day.

I wonder if they use Palantir software for the analysis?

Why? Outside of Palantir being extremely good at positioning itself as a product and services company vs a consulting shop that they truly are (with obvious significant boost to valuation this gives them).

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?

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

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.

What'd be the argument for that interpretation?

To note it, the article's figures are for submitted claims, not for approved claims.

true. it may be that they didn't pay out many, or any, of those claims. fair point.

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.

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!

I went to West Bloomfield high and lived in the area for while. And agree with you.

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?

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.

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...

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.

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.

> 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.

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

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

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

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