Category: Daily News

“Doctor shopping,” the growing practice of obtaining narcotic prescriptions from multiple providers, has led to measurable increases in drug use among postoperative trauma patients. The study, “Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population,” appearing in the August issue of the Journal of Bone and Joint Surgery(JBJS), links doctor shopping to higher narcotic use among orthopaedic patients. The data was presented earlier this year at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons(AAOS).

“There has been an alarming rise in opioid use in our country, and the diversion of opioids for non-therapeutic uses is dramatically increasing,” said lead study author, orthopaedic surgeon Brent J. Morris, MD. “Many suspect that orthopaedic trauma patients may be at a higher risk for pre-injury narcotic use and ‘doctor shopping.'”

Researchers reviewed prescription records for 151 adult patients admitted to an orthopaedic unit at a Level 1 trauma center between January and December 2011. Using the Tennessee Controlled Substance Monitoring Database (CSMD), the study authors reviewed data on narcotic prescriptions obtained three months before, and within six months after, each patient’s orthopaedic procedure. The research found that 20.8 percent of patients sought prescription pain medications from multiple providers. When compared to patients who continued to receive prescriptions and care from a single provider, the “doctor shoppers”:

1) Used narcotics four times longer than single provider patients (112 days versus 28 days).
2) Obtained a median of seven narcotic prescriptions compared to two prescriptions for single provider patients.
3) Had a higher morphine equivalent dose (MED) of narcotics each day (43 milligrams versus 26 milligrams).
4) Were 4.5 times more likely to seek out an additional provider if they had a history of preoperative narcotic use.

The “doctor shopping” patients had an average age of 39.6 ±12.2 years, and were primarily white (89 percent) and male (63 percent). Forty-four percent were uninsured. There were no differences between the single-provider and multiple-provider groups with regard to age, sex, race, injury type, distance between the patient’s home and treating hospital, tobacco use, psychiatric history (depression, anxiety, attention deficit hyperactivity disorder, or bipolar disorder), or comorbidities. “Our study determined that one out of five of our orthopaedic trauma patients obtained narcotic prescriptions from another provider after surgery while still receiving narcotic prescriptions from the treating surgeon,” said Dr. Morris.

The negative consequences of narcotic use and diversion of narcotics for nonmedical use in the United States are growing at dramatic rates Americans consume 80% of the global opioid supply and 99% of the global hydrocodone supply. The alarming rise in unintentional overdose deaths in the United States, which increased 124% from 1999 to 2007, is largely due to increases in prescription narcotic overdoses. Up to 20% of prescription drug abusers receive their narcotic supply from a single physician prescriber, while a growing percentage obtains narcotic prescriptions by seeking multiple providers (“doctor shopping”).

The former owner of a Los Angeles medical clinic management company pleaded guilty in connection with his role in a scheme to defraud Medicare.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California and Assistant Director in Charge Bill L. Lewis of the FBI’s Los Angeles Field Office made the announcement.

Mihran “Mike” Meguerian, 37, of Glendale, California, pleaded guilty before U.S. District Judge Beverly R. O’Connell in the Central District of California to one count of conspiracy to commit health care fraud.

According to court documents, Meguerian owned Med Serve Management (Med Serve), a medical clinic management company located in Van Nuys, California. Meguerian admitted that from approximately July 2008 through February 2009, he engaged in a conspiracy to commit health care fraud, in part through the operation of Med Serve. Meguerian admitted that he oversaw medical clinics that wrote prescriptions for medically unnecessary power wheelchairs and other durable medical equipment (DME). Meguerian and his co-conspirators then sold the prescriptions to DME supply companies, knowing that the prescriptions were fraudulent. The DME supply companies submitted the fraudulent prescriptions to Medicare in false and fraudulent claims.

From approximately July 2008 through February 2009, DME supply companies submitted approximately $3,367,661 in fraudulent claims to Medicare using fraudulent prescriptions from Meguerian’s clinics, and Medicare paid approximately $1,438,760 for those claims. Meguerian’s sentencing is scheduled for Nov. 17, 2014.

This case was investigated by the FBI and was brought as part of the Medicare Fraud Strike Force, which is supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. This case is being prosecuted by Trial Attorneys Fred Medick and Blanca Quintero of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,900 defendants who have collectively billed the Medicare program more than $6 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Eleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. “FBI warrant,” the agents called out, and a man in a T-shirt and shorts emerged. It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the Southern California doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services.

The story in the Wall Street Journal says that many strike-force investigations, including the Glazer case, start with an agent behind a computer screen, eyeing page after page of Medicare claims data, looking for unusual billing patterns. The Glazer case comes as the strike force increasingly targets physicians. “You need a doctor in all the schemes,” said David A. O’Neil, a deputy assistant attorney general for the criminal division who supervises strike-force prosecutions. He said the team charged 36 doctors with health-care fraud in the 2013 fiscal year, compared with just three in 2007, when many cases dug into fraud involving durable medical equipment such as wheelchairs.

The strike force’s Los Angeles team includes about 20 investigators and prosecutors working out of multiple offices, including a shiny tower in the suburbs near a strip mall dotted with family restaurants and chain stores. Last fiscal year, the strike force’s nine offices charged 350 people with health-care fraud, up from 122 charged when the strike force had just two offices. One agent described dealing with the voluminous number of potential cases as “Whac-A-Mole.”

Dr. Glazer attracted attention from authorities long before this year’s charges. In 1994, he was indicted with six others for an alleged referral scheme between 1986 and 1993. He was accused of paying $73,454 to a marketer during one 3½-year stretch to send him patients, according to California Superior Court documents obtained through a public-records request. Court documents indicate that the case was dismissed after a judge ruled that the prosecution’s witness testimony was inadmissible. Dr. Glazer was never excluded from billing Medicare, but patient complaints over billing prompted CMS several years ago to place him on “prepayment review,” according to people familiar with the situation. That meant any claims made to Medicare were manually reviewed by CMS contractors, a measure intended to prevent improper billing. Dr. Glazer was removed from the review list around 2009, these people said, although it isn’t clear whether CMS decided to take him off or if he appealed to an administrative judge. CMS said it doesn’t comment on administrative actions against individual providers. It is difficult to permanently ban a provider from Medicare. A criminal conviction or a loss of a state medical license can provide grounds to take a provider out of the system, and CMS can revoke billing privileges for reasons such as failing to comply with Medicare rules. Since 2011, CMS has revoked about 20,000 providers. But a provider can eventually appeal or reapply to return to the program.

The strike force began investigating him after sorting through years of his payment claims in the Medicare database, according to people familiar with the investigation. Such database searches look for “the sort of medically impossible or medically unlikely scenario,” said Supervisory Special Agent Robin McIlroy, who oversees the FBI’s part of the strike force. Between 2006 and 2014, Dr. Glazer’s family practice billed Medicare about $2 million, according to an affidavit by FBI Special Agent Janine Li, who was part of the investigation team. Between 2006 and 2014, Dr. Glazer’s family practice billed Medicare about $2 million, according to an affidavit by FBI Special Agent Janine Li, who was part of the investigation team.

When agents cross-referenced his Medicare provider number with other parts of the database – including claims data for home-health agencies, hospice and durable medical equipment – large billing numbers stood out, according to a person familiar with the investigation. “Once you start crunching the data, you start to see everything,” said Mr. Ferry, the special agent-in-charge. In the same eight-year time period, Dr. Glazer’s referrals to home health-care companies resulted in billings to Medicare for $16.5 million, and referrals to medical-equipment companies resulted in billings of about $5.4 million, the FBI’s Ms. Li said in her affidavit. Hospice services added up to about $10 million, according to a person familiar with the case.

Outliers popped up in the data. Using Dr. Glazer’s prescriptions, Medicare paid $2.5 million to one home-health agency down the hall from his office, while a local hospice was the recipient of nearly all his referrals, according to the person familiar with the case. Generally referrals are more spread out between multiple providers, said a person familiar with health-care fraud. The volume of motorized-wheelchair prescriptions in the data stunned the agents—an average of 134 a year, compared with a typical doctor working with elderly people who prescribed as few as one or two, according to the affidavit.

As the investigation progressed, agents in unmarked cars drove to Dr. Glazer’s clinic in Hollywood and watched. Located in a strip mall, along with a Salvadoran fast-food restaurant, a check cashier and a medical-supply company, the office received many elderly patients who spoke English as a second language, said the people familiar with the investigation. The agents interviewed patients drawn from the data, and a common allegation emerged: Dr. Glazer was billing Medicare for patient services sometimes never rendered and farming out patients to other providers, according to the indictment.

Pageant contestants seek the spotlight, but it was the limelight — on the Internet — that proved to be the incriminating evidence against a beauty pageant contestant collecting worker’s compensation for a fractured toe.

Shawna L. Palmer of Riverside started collected workers’ compensation benefits in March after fracturing her toe as a clerk at Stater Bros. Markets, according to a news release from the California Department of Insurance. She told her doctor during multiple visits that she couldn’t put weight on her foot or wear shoes for an extended period of time.

But a YouTube video of the 2014 Miss Toyota Long Beach Grand Prix beauty contest showed otherwise: She was seen walking around in high heels “without any signs of discomfort,” according to the Department of Insurance. “This suspect made the job of our departments’ detectives easier by openly participating in high profile events,” Insurance Commissioner Dave Jones said in a statement.

The news release said 22-year-old Palmer participated in at least two beauty contests while collecting workers’ compensation, even though her doctor had provided her an orthopedic boot, crutches and instructed her not to work.

According to officials, Shawna Lynn Palmer claimed to her employer March 10 that she was unable to continue working due to a foot injury she sustained as a clerk at Stater Bros. During multiple doctors visits, Palmer said she could not place any weight on her foot, could not wear any type of shoe for a period of time and could not move it in any direction. Palmer’s doctor provided her with an orthopedic shoe and crutches, and ordered her to refrain from working, along with elevating her foot whenever possible.

While collecting benefits, Palmer participated in at least two beauty contests, where she was seen walking in high heels without any signs of discomfort. It was the unusual delay back to work, however, that led investigators to look closer into the claim. Palmer was arrested after video evidence revealed her participation in the 2014 Miss Toyota Long Beach Grand Prix beauty contest.

If convicted, Palmer faces up to one year in county jail, three years of probation and must pay $24,000 in restitution.

The Division of Workers’ Compensation has posted the 2013 ethics advisory committee’s annual report on its web site. The workers’ compensation ethics advisory committee is a state committee independent from the DWC that is charged with reviewing and monitoring complaints of misconduct filed against workers’ compensation administrative law judges. The ethics advisory committee is required to make a public report each year summarizing activities in the previous calendar year. WCALJs are not subject to review by the California Commission on Judicial Performance, the agency which is responsible for investigating misconduct complaints directed at judges serving on the Supreme, Superior and Appellate courts.The Ethics Advisory Committee is composed of nine members, each appointed by the Administrative Director of the DWC’s for a term of four years. The EAC is assisted in carrying out its functions by an attorney and secretary on the staff of the DWC.

Any person may file a complaint with the EAC. Complaints must be presented in writing and the EAC will accept anonymous complaints. An EAC case is typically opened as a result of receipt by the DWC of a letter from an injured worker, an attorney, or lien claimant who has been a party to a proceeding before a workers’ compensation administrative law judge employed by the DWC and the complaint alleges ethical misconduct by the WCALJ. In 2013, the DWC had authority over 167 active judges in 24 district office locations. The EAC considered a total of 34 of the 37 new complaints it received in the calendar year of 2013, in addition to 3 complaints pending from 2012. Most of the complaints (24) were filed by unrepresented workers. Two each were filed by applicant and defense attorneys.

Of the 33 resolved complaints, the EAC identified one complaint resulting in judicial misconduct. In that case an unrepresented applicant, complained that the judge threatened and harassed the complainant, and the complainant claimed his well-being was in danger. Complainant attached the transcript of the hearing wherein the judge stated, “if you interrupt me one more time, you will deeply regret it. I have been sitting trying to say things, and you have been constantly interrupting me. I am on the bench, and I will suffer no more interruptions.” Complainant alleged that the judge said this in a very loud voice. Following its review of the complaint, the Committee identified an ethical violation of the Code of Judicial Ethics. Based upon that conclusion, the Committee has recommended further action. Appropriate action has taken place.

One of the more interesting situations that were not resolved involves an anonymous complainant who complained that the judge acted unprofessionally during hearings in the courtroom. At a hearing, a brand new attorney, accompanied by a senior member of the firm, was making a first appearance before the judge. When the young attorney was introduced, the judge loudly questioned the young attorney in front of all parties present as to whether or not the attorney had been informed by other members of the bar that the WCALJ is a “real bitch.” Parties in the courtroom were shocked and dismayed by the judge’s unprofessional behavior. The complaint was made anonymously because of the fear of retaliation by the judge. This was one of three complaints filed after the Final EAC meeting of 2013. The outcome of this complaint will no doubt appear in next years report.