Four Detroit-area physicians were found guilty by a federal jury Tuesday of healthcare fraud after they administered doses of unnecessary—and sometimes painful—back injections to patients in exchange for prescriptions of more than 6.6 million doses of medically unnecessary opioids.
The doctors required patients to get the injections in order to get the prescriptions for opioids, some of which were resold on the street by drug dealers, according to the Department of Justice (DOJ). Then they billed Medicare for the medically unnecessary injections in the more than $150 million healthcare fraud scheme.
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The defendants were among some of the top prescribers of oxycodone in Michigan. In testimony, the practice was described as an assembly line where the doctors earned anywhere from $1,100 to $3,500 an hour for performing the same injections on nearly every patient.
The doctors worked at medical clinics in Michigan and Ohio operated under the name of the Tri-County Group, which was paid more for these facet joint injections than any other medical clinic in the U.S., the DOJ said.
Prosecutors said that the doctors offered prescriptions of 30-mg oxycodone pills to patients, a dosage suitable only for terminally ill cancer patients. Over 94% of the patients in the clinic were caught in the fraud scheme.
Seventeen other defendants, including eight other doctors, previously pleaded guilty in connection with the investigation.
Following a four-week trial, a jury found the four doctors guilty of one count of conspiracy to commit healthcare fraud and wire fraud and one count of healthcare fraud. The doctors were Spilios Pappas, M.D., 62, of Lucas County, Ohio; Joseph Betro, D.O., 59, of Oakland County, Michigan; Tariq Omar, 62, M.D., of Oakland County, Michigan; and Mohammed Zahoor, M.D., 53, of Oakland County, Michigan.
Sentencing has been scheduled on separate dates in July before Chief U.S. District Judge Denise Page Hood of the Eastern District of Michigan, who presided over the trial.
“These physicians subjected patients to medically unnecessary injections to reap millions in fraudulent billings. Worse still, they incentivized those treatments by offering opioid prescriptions in sky-high dosages meant for the terminally ill,” said Assistant Attorney General Brian Benczkowski of the DOJ’s Criminal Division. “Today’s verdict shows that the department will root out physicians who let dollar signs, rather than medical need, drive their treatment of patients.”
The case
According to evidence presented at trial, the four doctors worked at clinics operated by Tri-County Group owned by co-conspirator Mashiyat Rashid from 2008 to 2016. He pleaded guilty in 2018 for his role in the fraud scheme.
Law enforcement officials said the doctors billed for medically unnecessary facet joint injections, unnecessary urinary drug screens, home health and myriad other unneeded ancillary services.
Prosecutors said that the doctors offered prescriptions of 30-mg oxycodone pills to patients, some of whom were suffering from legitimate pain and others who were drug dealers or opioid addicts. The patients were forced to submit to unnecessary facet injections in exchange for the pain medication.
In testimony at trial, some patients said they experienced more pain from the shots than the pain they had come to have treated, and some developed adverse conditions, including open holes in their back. Patients, including those who were addicted to opioids, told the doctors that they did not want, need or benefit from the injections but were denied medication by the doctors and their co-conspirators until they agreed to submit to the expensive and unnecessary injections, the DOJ said.
The evidence further established that the defendants repeatedly performed these unnecessary injections on patients. The four defendants were all ranked in the top 25 doctors for dollars paid by Medicare for facet joint injections, even though they only worked a few hours a week.
Additionally, the doctors signed a standing order for urine tests for each patient for every visit, tests that were sent to National Laboratories, a company owned by Rashid, in exchange for tens of thousands of dollars in illegal kickbacks, the DOJ said. The evidence further established that the physicians performed a quantitative test for 56 different drugs for every patient at every visit, regardless of whether the patients presented any reason for the test.
The physicians prescribed narcotics, including opioids and benzodiazepines, as an incentive to patients who received the injections. Evidence from the Michigan Automated Prescription System showed that the four defendants were among some of the top prescribers of oxycodone 30 mg in the state of Michigan.
In 2015, Pappas was the No. 7 prescriber of oxycodone 30 mg in the state of Michigan; Betro, 18; Omar, 16; and Zahoor, 38, the evidence showed.
At trial, oxycodone 30 mg was described as the “gold standard” of drugs diverted to illegal purposes on the street. Evidence showed that all four defendants were in the top 40 out of 50,000 Michigan prescribers even though they had conspired with Rashid to “stay under the radar” of the U.S. Drug Enforcement Administration by working only a few hours a week, the DOJ said.
The doctors would see anywhere from 15 to 25 patients in a two- to four-hour shift and then bill Medicare for office visits and procedure codes suggesting that they spent as much as two hours and 22 minutes with each patient, prosecutors said.