The U.S. Justice
Department released the below information:
PHILADELPHIA – United
States Attorney William M. McSwain joined fellow Justice Department officials
today at a press conference to announce a coordinated health care fraud
enforcement action across seven federal districts involving more than $800
million in loss and the distribution of over 3.25 million opioid pills in “pill
mill” clinics. The takedown includes new charges against 48 defendants for
their roles in submitting over $160 million in fraudulent claims. Of those 48
defendants, 15 are doctors or medical professionals, and at least 24 defendants
were charged for their roles in diverting opioids. In the Eastern District of
Pennsylvania, 17 defendants (five of whom are doctors or medical professionals)
were arrested, and the conduct involved submission of more than $4 million in
fraudulent claims and distribution of approximately 738,000 oxycodone pills to
the streets of this District.
Today’s announcement
comes one year after the Department of Justice announced the formation of the
Newark/Philadelphia Regional Medicare Fraud Strike Force, a joint law
enforcement effort that brings together the resources and expertise of the
Health Care Fraud Unit in the Criminal Division’s Fraud Section, and the U.S.
Attorney’s Offices for the Eastern District of Pennsylvania and the District of
New Jersey. The Strike Force focuses its efforts on aggressively investigating
and prosecuting complex cases involving patient harm, large financial loss, and
the illegal prescribing and distribution of opioids and other dangerous
narcotics.
“As today’s takedown
demonstrates, this Strike Force has produced precisely what we hoped it would –
and by that I mean tangible results,” said U.S. Attorney McSwain. “We have
brought together a wealth of resources, knowledge, and subject-matter expertise
– that of health care fraud prosecutors, civil enforcement attorneys, data
analysts, and law enforcement agencies – all working to stop fraud, waste, and
abuse within our federal health care programs and to stem the tide of illegal
opioid distribution. These are top priorities of the Department of Justice and
of my Office, and our focus in this area continues to pay off.”
At the press
conference, U.S. Attorney McSwain announced details about the following cases
charged in the Eastern District of Pennsylvania:
Timothy F. Shawl,
M.D., 60, of Garnet Valley, PA, a medical doctor, was charged with five counts
of unlawful distribution of controlled substances. He allegedly wrote
prescriptions for controlled substances that were outside the usual course of
professional practice and not for a legitimate medical purpose. As alleged in
the indictment, Shawl wrote prescriptions for controlled substances for
patients without seeing, treating, or examining them. Shawl allegedly
prescribed hundreds of prescriptions for oxycodone to approximately 16
patients, amounting to over 29,000 oxycodone tablets. The Federal Bureau of
Investigation (FBI) conducted the investigation. The case is being prosecuted
by Trial Attorney Debra Jaroslawicz of the DOJ Fraud Section.
The second case
involves defendants Neil K. Anand, M.D., 42, of Bensalem, PA, and Asif Kundi,
31, Atif Mahmood Malik, 34, and Viktoriya Makarova, 33, all of Philadelphia,
PA. Anand, a medical doctor, Kundi and Malik, unlicensed foreign medical school
graduates, and Makarova, a nurse practitioner, were each indicted on one count
of health care fraud and one count of conspiracy to distribute controlled
substances. The charges stem from the defendants’ alleged submission of false
and fraudulent claims to Medicare, health plans provided by the United States
Office of Personnel Management (OPM), and Independence Blue Cross (IBC). The
claims allegedly were for “Goody Bags,” which were stuffed with medically
unnecessary prescription medications that were dispensed by non-pharmacy
dispensing sites owned by Anand. In total, Medicare, OPM, and IBC allegedly
paid over $4 million for the Goody Bags. Patients were allegedly required to
take the Goody Bags in order to receive prescriptions for controlled
substances.
According to the
indictment, Malik and Kundi wrote prescriptions for controlled substances using
blank prescriptions that were pre-signed by Anand or Makarova. Anand and
Makarova provided over 10,000 prescriptions for Schedule II controlled
substances, of which over 7,000 were for oxycodone, for a staggering total of
over 634,000 oxycodone tablets distributed from this scheme. The investigation
was conducted by the following agencies: FBI, Department of Health and Human
Services – Office of Inspector General (HHS-OIG), United States Postal Service
– Office of Inspector General (USPS-OIG), the Office of Personnel Management,
the Pennsylvania Office of Attorney General, and the Philadelphia Police
Department. The case is being prosecuted by DOJ Trial Attorney Jaroslawicz.
Additionally, 12
indictments were unsealed yesterday involving charges against 12 people for
allegedly possessing oxycodone with intent to distribute. The indictments
charge that, from September 2016 through June 2019, the 12 defendants all
presented forged prescriptions for oxycodone to various pharmacies outside of
Philadelphia, in order to obtain oxycodone to distribute to others. The
defendants, all from Philadelphia, allegedly drove to Pennsylvania pharmacies
in Marcus Hook, Drexel Hill, and Kennett Square, and a New Jersey pharmacy in
Mount Laurel, to fill these forged prescriptions. The defendants are charged
with at least two, and up to 32, counts of possession with intent to distribute
oxycodone. The defendants are charged with having received anywhere from 6,300
milligrams to 135,000 milligrams of oxycodone, which is approximately 75,000
oxycodone pills.
Charged were: Lamar
Dillard, 37; Jermaine Grant, 29; Katrina Tucker, 32; Maurice Bertrand, 31;
Courtney Brockenborough, 34; Alan Alexander Harrison, 29; Abdullah Howard, 23;
Jonathan Metellus, 32; Clinton Monte Bullock, 29; Crystal Coleman, 31; Marques
Russell, 35; and Joseph Michael Simmons. One defendant, Metellus, is also
charged with one count of health care fraud, for allegedly using his Medicaid
card to purchase prescription drugs with a forged prescription. These cases
were investigated by the Drug Enforcement Administration, HHS-OIG, the
Pennsylvania Department of State’s Bureau of Enforcement and Investigations,
the Chester County District Attorney’s Office, and the Easttown Township Police
Department. They are being prosecuted by Assistant U.S. Attorneys David E.
Troyer, Elizabeth Abrams, Joan Burnes, and Mary Kay Costello, all of the
Eastern District of Pennsylvania.
Today’s enforcement
actions were led and coordinated by the Health Care Fraud Unit of the Criminal
Division’s Fraud Section, in conjunction with its Medicare Fraud Strike Force,
as well as the U.S. Attorney’s Offices for the Eastern District of
Pennsylvania, District of New Jersey, Western District of Pennsylvania, Eastern
District of New York, Western District of New York, District of Connecticut,
and District of Columbia.
“Physicians and other
medical professionals who fraudulently bill our federal health care programs are
stealing from taxpayers and robbing vulnerable patients of necessary medical
care. The medical professionals and others engaging in criminal behavior by
peddling opioids for profit continue to fuel our nation’s drug crisis,” said
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s
Criminal Division. “The Department of Justice will continue to use every tool
at our disposal, including data analytics and traditional law enforcement
techniques, to investigate, prosecute, and punish this reprehensible behavior
and protect federal programs from abuse.”
“Today's indictments
confirm the FBI's commitment to hunting down doctors and other healthcare
professionals who act like drug dealers. The opioid crisis is devastating
families here in Philadelphia and across the country. The FBI and its law
enforcement partners will continue to focus on corrupt physicians and others
driving the epidemic,” said Michael T. Harpster, Special Agent in Charge of the
Philadelphia Division of the FBI.
“Today’s law
enforcement actions show we are holding alleged bad actors accountable and
working to prevent further harm to beneficiaries and taxpayers,” said Maureen
R. Dixon, Special Agent in Charge, Philadelphia Regional Office of the
Inspector General, U.S. Department of Health and Human Services. “HHS-OIG will
continue to work with our law enforcement and community partners to combat
health care fraud and drug diversion in the Philadelphia Region.”
“The DEA’s Diversion
Investigators and Tactical Diversion Squads are missioned with the
identification, investigation, and arrest of rogue DEA Registrants and drug
trafficking organizations involved in the illegal distribution of controlled
substances such as oxycodone and other prescription painkillers,” said Jonathan
A. Wilson, Special Agent in Charge of the DEA’s Philadelphia Field Division.
“Working with our partner agencies such as the U.S. Department of Health &
Human Services, the U.S. Department of Labor, and the Federal Bureau of
Investigation, the DEA will continue to pursue federal criminal cases and
parallel civil proceedings against the registrants and organizations that seek
to divert these powerful painkillers that have contributed to the opioid
epidemic.”
U.S. Postal Service
Office of Inspector General Special Agent in Charge Kenneth Cleevely, Eastern
Area Field Office, stated: “The Postal Service spends billions of dollars per
year on health care related costs for postal employees, the majority of which
is for legitimate purposes. However, a few medical providers try to take
advantage of the system. USPS – OIG special agents will vigorously investigate
health care fraud allegations that touch the Postal Service and will work with
our law enforcement partners to bring fraudsters to justice.”
“The opioid, heroin,
and fentanyl epidemic is devastating Pennsylvania communities, and it is fueled
in part by prescription drug abuse,” said Pennsylvania Attorney General Josh
Shapiro. “The defendants had a responsibility to help their patients, but
instead they are charged with giving them dangerous opioids that they did not
need. They also allegedly committed millions of dollars in insurance fraud,
which causes rates for all consumers to increase. I’m proud to work with our
law enforcement partners to put a stop to this criminal enterprise and protect
the people of Pennsylvania.”
A complaint,
information or indictment is merely an allegation, and all defendants are
presumed innocent until proven guilty beyond a reasonable doubt in a court of
law.