Tuesday, August 14, 2012

Canton Resident Convicted in Health Care Fraud Scheme

A Canton pharmacist and pharmacy owner, along with five other associates, were found guilty by a federal jury on 26 counts of an indictment charging him with conspiracy, health care fraud, and controlled substance distribution, United States Attorney Barbara L. McQuade announced today.
The jury deliberated a little more than three days before returning the verdict, concluding a six-week trial before United States District Judge Arthur J. Tarnow.
McQuade was joined in the announcement by Special Agent in Charge Robert L. Corso of the Drug Enforcement Administration; Special Agent in Charge Robert D. Foley, III of the Federal Bureau of Investigation; and Lamont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services.
The jury convicted Babubhai (Bob) Patel, 49, and four pharmacists he employed, Brijesh Rawal, 36, of Canton; Ashwini Sharma, 34, of Novi; Lokesh Tayal, 36, of Northville; and Viral Thaker, 31 of Findlay, Ohio; and one of Patel’s business associates, Komal Acharya, 28, of Farmington Hills. Brijesh Rawal, Ashwini Sharma, Lokesh Tayal, and Viral Thaker were convicted of conspiracies to commit health care fraud and to distribute controlled substances; Komal Acharya was convicted of the sole charge she faced, conspiracy to commit health care fraud. In addition, Brijesh Rawal was convicted of one count of substantive health care fraud and three counts of substantive controlled substance distribution, in addition to the conspiracies; Viral Thaker was convicted of two substantive health care fraud counts and two substantive distribution counts. The jury was unable to reach a verdict on the sole count pending against Harpreet Sachdeva.
“These defendants stole money from the Medicare and Medicaid programs, which are designed to provide health care and medicine to some of our most vulnerable citizens,” McQuade said. “Pharmacists and health care providers should be aware that we are scrutinizing records to detect and prosecute health care fraud,” McQuade said.
Robert L. Corso, Special Agent in Charge of DEA’s Detroit Field Division stated, “Confronting the illegal diversion and abuse of controlled pharmaceuticals is a top priority of DEA and our law enforcement partners. Today’s verdicts eliminated one of the largest diversion conspiracies ever uncovered in the state of Michigan. The convictions, particularly of the medical professionals, are significant. These individuals abused their positions of trust and endangered the lives of countless people by illegally distributing opiate painkillers and depressants throughout southeast Michigan and beyond. This investigation makes it clear that the DEA and our partners in law enforcement will continue to investigate and bring to justice those individuals that are responsible for the illegal distribution of prescription medicines.”
“The diversion of prescription drugs, coupled with the submission of fraudulent claims to Medicare, creates a toxic scenario that can place an individual’s health and safety at risk as well as taxpayers’ dollars,” said Lamont Pugh, III, Special Agent in Charge of the Chicago Region for the U.S. Department of Health and Human Services, Office of Inspector General. “The OIG will continue to work diligently with our law enforcement partners to hold those who seek to harm the Medicare program accountable.”
FBI Special Agent in Charge Foley stated, “Those who abuse our health care system by stealing tax payer dollars will be brought to justice. Pharmacists and others who engage in criminal activity in order to enrich themselves financially will be held accountable for their illegal acts. The FBI is committed to stopping this form of fraud.”
The evidence presented at trial demonstrated that, from approximately January 2006 through August 2011, Babubhai Patel owned and controlled over 20 pharmacies, which were operated in and around Detroit, Michigan. In addition, the evidence showed that Patel’s model for turning a profit at his pharmacies was based upon large-scale health care fraud and the diversion of controlled substances. Patel and his associates paid cash kickbacks and other forms of illegal remuneration to physicians in exchange for those physicians writing prescriptions for expensive medications, without regard to medical necessity, that could be billed to Medicare, Medicaid, or a private insurer through one of the Patel Pharmacies. Physicians affiliated with Babubhai Patel would also write prescriptions for controlled substances for their patients, again regardless of medical necessity, which would then be filled at one of the Patel Pharmacies. These controlled substances were distributed to patients and patient recruiters as a kickback in exchange for the patients using a Patel Pharmacy.
Pharmacists within the Patel Pharmacies, including defendants Rawal, Tayal, Sharma, and Thaker, facilitated the fraud and controlled substance distribution schemes by billing Medicare, Medicaid, and private insurers for expensive, non-controlled medications that they had in inventory but never actually dispensed to the patients. The surplus of medications generated through this practice was returned to wholesalers, thereby enabling the Patel organization to maximize its profit on its inventory of medications which were billed for but never dispensed. The defendants billed insurers for dispensing medications that they knew were prescribed outside the course of legitimate medical practice, thus defrauding insurers by billing for medications regardless of medical necessity. The defendants would provide controlled drugs to patients and patient recruiters, knowing that those medications were prescribed outside the course of legitimate medical practice.
Evidence also showed that Acharya assisted Patel in sustaining the illegal health care fraud scheme at his pharmacies, principally by helping Patel and others conceal the proceeds of the fraud.
The case was investigated by the DEA, the Department of Health and Human Services-Office of Inspector General, and the FBI. The case was prosecuted by Assistant United States Attorneys John K. Neal and Wayne F. Pratt.

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