Kentucky doctors, pharmacists, and medical professionals have been charged with Medicaid fraud in one of the biggest sweeps ever.

Dr. Christopher Nelson of the Bluegrass Pain Consultants in Louisville was indicted on federal charges of Medicaid fraud. The U.S. Department of Justice says the doctor allegedly teamed up with a pharmacy to routinely defraud Medicare and Tricare through increased drug costs. Nelson’s kickback scheme allegedly directed his patients to Assured Rx to purchase pain control drugs, where they were reportedly charged more – resulting in fraudulent claims to Medicare and Tricare.

In a five-month period in 2015, Nelson allegedly earned $225,700 in illicit profits paid to ETN LLC (a company set up in a relative’s name). The government also accuses the doctor of accepting an additional $282,000 in kickbacks between July 2015 and January 2016 through a separate company set up by a friend.

Nelson also faces claims that he paid bonuses to nurse practitioners and physician assistants at Bluegrass Pain Consultants for the prescribed drugs that were filled by Assured Rx.

“We look forward to receiving discovery from the government, reviewing it and going forward from there,” Nelson’s attorney told Courier Journal.

Assured Rx, the pharmaceutical company allegedly involved in the Medicaid fraud scheme, has also been indicted by the government. The pharmacy is accused of bribing Nelson and filing fraudulent Medicare and Tricare claims as a result of their increased drug prices.

“What we’re charging today, what we will continue to investigate and charge, are examples of criminal medical conduct that places patients at risk,” said Russell Coleman, U.S. Attorney for the Western District of Kentucky, according to Courier Journal.

The government has also indicted Dr. Ijaz Mahmood, another doctor accused of authorizing prescriptions while he wasn’t even in the country. In some cases, these prescriptions were for controlled substances such as narcotics.

Prosecutors in the Medicare fraud case claim that Mahmood provided pre-signed, blank prescriptions to his office staff so that they could approve narcotics prescriptions for their patients when he was not around.

Other doctors indicted by the government in this large sweep include Dr. Mohammed A.H. Mazumder, Dr. Scotty R. Akers, Dr. Denver D. Tackett and Dr. Sai P. Gutti.

There are numerous forms of Medicaid fraud that can allow deceitful companies to collect money from the government under fraudulent circumstances. Some common forms of federal healthcare fraud include:

• Phantom billing: When a medical provider bills Medicaid for procedures that are medically unnecessary or are not performed;
• Patient billing: A patient is in on the Medicaid scam and provides their information in exchange for kickbacks;
• Upcoding and unbundling: This occurs when medical offices utilize medical coding and billing to upcharge on services or classify separate parts of a procedure as different items to bill.

Fraud in Medicaid, Medicare, and Tricare is widespread in America. According to the National Conference of State Legislatures, improper payments alone cost the government more than $29 billion in 2015. When this money is tangled up in fraud, these funds are unable to be used to benefit Americans who need assistance with health services.

This article is not legal advice. It is presented
for informational purposes only.