BOSTON – A Brookline doctor has pleaded guilty, was sentenced to jail, and has been ordered to pay $9.3 million in restitution for running an intricate Medicaid fraud scheme involving millions of dollars in taxpayer funds, Attorney General Maura Healey announced last month.
Dr. Punyamurtula Kishore, 64, along with his company Preventive Medicine Associates, Inc. (PMA), pleaded guilty in Suffolk Superior Court. PMA pleaded guilty to charges of Medicaid Kickbacks (8 counts), Medicaid False Claims (19 counts) and Larceny over $250 (11 counts). Dr. Kishore pleaded guilty to one count of Larceny over $250.
“Dr. Kishore orchestrated a complex kickback scheme to funnel a lucrative drug screening business to his laboratories and then billed taxpayers millions of dollars for those services,” AG Healey said. “This case exhibited blatant theft of state funds that were supposed to go toward care for some of our most vulnerable residents. This is fraud that undermines the integrity of our health care system.
Superior Court Judge Janet Sanders sentenced Kishore to 360 days in the House of Correction, with 11 months to serve and the balance suspended for 10 years. As a condition to his sentence, Kishore has also agreed to surrender his medical license. Judge Sanders also ordered Kishore and PMA to pay, jointly and severally, a total of $9.3 million in restitution.
Dr. Kishore previously owned and managed PMA, a network of 29 medical branches throughout Massachusetts, including physician office laboratories and one independent clinical laboratory. Based on the AG’s investigation, Dr. Kishore used bribes, or kickbacks, to induce sober house owners to send their residents’ urine drug screening business to his laboratories for testing. Residents were typically screened three times per week.
A urine drug screen may be billed to MassHealth by a physician if the screen is medically necessary. Drug screens generally are billed to the MassHealth program for approximately $100 to $200. Dr. Kishore manipulated his business relationships with sober house owners to illegally obtain tens of thousands of drug screens paid for by MassHealth for sober house residents who were never treated by PMA providers.
In September 2011, Dr. Kishore and PMA were indicted, and individually charged with Medicaid Kickbacks (8 counts), and Medicaid False Claims (8 counts). In November 2013, Dr. Kishore and PMA were indicted on additional charges of Medicaid False Claims (11 counts) and Larceny over $250 (11 counts) for billing MassHealth for millions of dollars in drug screens using the names of PMA physicians and nurse practitioners who were not actually treating the patients or determining the drug screens to be medically necessary. State regulations require that the services must be medically necessary and the provider must be physically present and actively involved in the treatment of the member.
Two other individuals previously pleaded guilty to one count of Medicaid Kickbacks in connection with their involvement in Dr. Kishore’s scheme to defraud MassHealth. In June 2012, Damion Smith, 42, of New Jersey, president of Fresh Start Recovery Coalition, was sentenced to two years in the House of Correction suspended for two years with probation. Carl Smith, 69, of Dorchester, manager of New Horizon House, pleaded guilty in January 2015 and was sentenced to two years in the House of Correction suspended for two years with probation.
The case against Thomas Leonard of Malden, the part owner and manager of the Marshall House, a sober house located in Malden, is ongoing. John Coughlin of Carver, president of Gianna’s House Inc., which operates several sober houses located in Wareham, New Bedford, and Sandwich, began his trial today in Suffolk Superior Court.
This case, first referred to the AG’s Office by MassHealth, was prosecuted by Assistant Attorneys General Angela Neal, David Scheffler, and Lee Hettinger of AG Healey’s Medicaid Fraud Division with the assistance of victim witness advocates John Malone and Amber Anderson. The case was investigated by Erica Schlain and Denise Long of the Attorney General’s Office, Massachusetts State Police assigned to the Attorney General’s Office, Examiners from AG Healey’s Computer Forensics Lab, Special Agents from the Boston Office of the United States Department of Health and Human Services Office of the Inspector General, and investigators from the Massachusetts Insurance Fraud Bureau also assisted in this case.
NOTE: Don’t be led to believe that so long as one stays away from Medicare or Medicaid dollars, there is no crime being committed. If anything, the Florida Patient Brokering Act, s. 817.505, Fla. Stat., would make such kickbacks illegal as a felony, per count.
What’s the takeaway – don’t get involved in the Substance Use Disorder treatment business if your goal is to make money on UA screenings. As it was said above, it undermines the integrity of the entire healthcare system and regulators will, ultimately, come after you, one way or another.