Sarasota, FL (WorkersCompensation.com) – The Appalachian region has always been fraught with woe and despair. Some studies have supported that reputation, showing a higher rate of mental illness among Appalachian mine workers. Additionally, a new report shows a spike in deaths resulting from drug overdoses while on the job.
Given the history of issues, it’s no surprise that the OIG and the Department of Justice (DOJ) have focused on drug activity in the Appalachian Region and surrounding areas in the previous months. In fact, the Appalachian Regional Prescription Opioid (ARPO) Strike Force, a healthcare fraud unit of the DOJ, and the OIG recently teamed up to announce charges filed against 12 medical professionals and 2 additional defendants in 8 federal districts located in the Appalachian states of Kentucky, West Virginia, Tennessee, Ohio and Alabama, as well as Florida, and New Jersey. The case involves over 5.1 million pills, and $7 million in reimbursement.
In Kentucky, physician Loey Kousa of Paintsville and dentist Jay M. Sadrinia of Villa Hills were both with charged with unlawful distribution of controlled substances. In addition to the drug charges, Kousa was charged with making false statements regarding delivery of healthcare services. Investigators allege that in the course as the owner and operator of East KY Clinic, Kousa issued prescriptions outside his scope of care and without properly seeing the patient. Additionally, investigators assert that Kousa over billed federal payers for higher-level evaluation and management codes when he had only seen the patient for a few moments.
In the indictments for Sadrinia, he as been charged with four counts for distribution of oxycodone and morphine sulfate, and one count of illegal distribution of morphine sulfate, resulting in death or serious bodily injury that could result in 20 years to life. As an owner of multiple practices, investigators assert that Sardrinia not only prescribed outside his course of care and without legitimate medical purpose, but also issued multiple prescriptions in a short time frame to a patient who ultimately overdosed. In an 8-day period, Sadrinia issued two prescriptions of oxycodone totaling 60 milles, and two morphine prescriptions totaling 48 pills.
In West Virginia, Frederick De Mesa was charged with unlawful distribution of controlled substances such as tramadol. Per the indictment, De Mesa worked at Squire medical Center but was not a licensed medical professional and did not have a DEA license. However, investigators assert that De Mesa used the DEA license of a relative to write prescriptions for opioids.
Physician Yogeshwar Gill operated a family practice in east Tennessee, and often prescribed Schedule II and Schedule III substances such as hydrocodone and oxycodone, as well as buprenorphine. The indictment asserts that Yogeshwar not only issued prescriptions outside the course of valid medical care and his scope of practice, but also schemed to dispense and distribute controlled substances.
In middle Tennessee, Contessa Holley was charged by indictment with wire fraud, aggravated identity theft, and possession of a controlled substance with intent to distribute. A former nurse and clinical director, Holley allegedly used the information of previous hospice patients to fill thousands of prescriptions for hydrocodone and oxycodone pills. According to the indictment, Holley used the patient’s information to obtain the drugs and cover costs of the medication, but kept the pills herself or distributed them.
Also in middle Tennessee, Hau T La was charged per indictment with sixteen counts of unlawful distribution. A medical doctor licensed in 2007, La owned and operated Absolute Medical Care. The indictment asserts that La prescribed opioids to eight patients outside his scope of practice without medical necessity.
For the state of Ohio, physicians Eskender Getachew and Charles Kistler were both charged with unlawful distribution of controlled substances. Getachew has been accused of issuing prescriptions for buprenorphine, dextroamphetamine-amphetamine, and clonazepam outside the course of medical treatment. Kistler, aged 77, prescribed hydrocodone and other controlled substances outside his scope of medical practice, according to the indictment.
Francene Aretha Gayle of Florida, and Schara Monique Davis of Alabama were also charged with conspiracy to unlawfully distribute controlled substances, conspiracy to commit health care fraud, and healthcare fraud. The two individuals operated several medical clinics in which Gayle was the sole physician and Davis was the business manager. The pair allegedly billed for clinic visits under Gayle’s information when other staff saw the patients. Additionally, investigators assert that Gayle pre-signed prescriptions for opioids that were issued in her absence.
Also in Florida, Neighborhood Pharmacy owner Casey Kelleher was charged with conspiracy to unlawfully distribute controlled substances. According to the indictment, Kelleher’s pharmacy was the largest purchaser or opioids in its zip code. Instead of using the pills to fill prescriptions, investigators asser that over a 2 year period Kelleher sold a total of 342,407 opioids, including oxycodone and hydromorphone, on the black market.
In New Jersey, physician Robert K Taffert was charged by criminal complaint for conspiracy to unlawfully distribute. The complaint alleges that Taffert falsified medical records to show he had interacted with and assessed patients when he had not, and then issued prescriptions for opioids in those cases. Although Taffet had maintained an active DEA, he was not authorized to prescribe controlled substances for the treatment of narcotic addiction. Additionally, upon analyzing Taffert’s prescription practices, 88.33 percent of the surveilled patients received prescriptions that were two or more times greater than the CDC recommended rate, resulting in 179,000 oxycodone pills prescribed.