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MORE HEALTHCARE FRAUD

I was just thinking how much has changed in healthcare since I wrote the CORRIDOR and THE PAIN DOC WHEN THIS APPEARED IN CRAIN'S
Scheme allegedly involved millions of opioid drugs, unnecessary medical procedures
Doctor operated clinics in Warren, Eastpointe
Nearly $500 million was billed to insurers, mostly Medicare and Medicaid
Five metro Detroit doctors and one from the Grand Rapids area have been indicted for allegedly running a $464 million health care fraud scheme that involved millions of opioid drugs and unnecessary medical procedures in Southeastern Michigan, federal officials announced Thursday.

An indictment unsealed Thursday says the doctors prescribed opioids to induce people to visit and patients were forced to undergo other treatments.

Nearly $500 million was billed to insurers, mostly Medicare and Medicaid, the officials said. Doctors submitted claims of more than $182.5 million to Medicare, $272.6 million to Medicaid and $9.2 million to Blue Cross Blue Shield of Michigan, prosecutors allege.

The alleged ringleader was Rajendra Bothra, M.D., who operated pain clinics in Warren and Eastpointe. He's charged with conspiracy, fraud and other crimes. The identity of his lawyer wasn't immediately known.


U.S. Attorney Matthew Schneider said it's "particularly egregious" for doctors to prey on addicts.

The 56 count indictment cites three clinics in Macomb County: The Pain Center USA PLLC at 27423 Van Dyke Ave., Suite A, in Warren, and 22480 Kelly Road in Eastpointe; and Interventional Pain Center PLLC, also at 27423 Van Dyke.

Four of the doctors were to be arraigned in federal court Thursday afternoon, according to a news release from the U.S. Attorney's Office Eastern District of Michigan

The indictment charges that Bothra, 77, of Bloomfield Hills, owned and operated a pain clinic in Warren that sought to bill insurance companies for the maximum number of services and procedures possible with no regard to the patients' needs. Dr. Eric Backos, 65, of Bloomfield Hills; Dr. Ganiu Edu, 50, of Southfield; Dr. David Lewis, 41, of Detroit; Dr. Christopher Russo, 50 of Birmingham; and Dr. Ronald Kufner, 68 of Ada, all worked at the clinic in varying capacities but each prescribed opioid pain medication to induce patients to come in for office visits. Once there, in order to receive the highly addictive opioid prescriptions, patients were forced to undergo ancillary services, such as painful facet joint and facet block injections.

The doctors are accused of issuing more than 13,217,987 doses of opioids, including oxycodone, oxymorphone, hydrocodone, and hydromorphone, from January 2013 through November 2018.

Bothra allegedly submitted false claims to insurance providers for service and devices that were "medically unnecessary," according to the indictment, and attempted to conceal that he submitted fabricated claims to insurance providers.

A call was placed Thursday to the medical clinic in Eastpointe, where a woman from the answering service who did not identify herself said the clinic is closed due to the raid and investigation.

The case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation.The Eastern District of Michigan is one of the districts included in the Opioid Fraud Abuse and Detection Unit.


— Crain's Detroit Business reporter Kurt Nagl and the Associated Press contributed to this report. Read More 
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