Psychiatrist jailed for 16 months for immigration fraud; failed disclose drug crime on residency application

On September 29, 2010, Nigerian psychiatrist Chidozie Emmanuel Onovo was sentenced to 16 months in jail on three counts of immigration fraud, for failing to declare his criminal history when applying for a New Zealand visa in 2008.

Onovo qualified as a doctor in Nigeria in 1996, worked in Ireland from 2004 until January 2009 and worked for the Canterbury District Health Board (New Zealand) from January 2009 until August 2010.

In 1999, Onovo was convicted of smuggling cannabis into Britain and was jailed for two years.  In his New Zealand residency application, Onovo forged letters from hospitals in Nigeria, claiming he was working during the time when he was actually in prison.

Source: “Drug smuggling psychiatrist jailed,” Manawatu Standard, September 30, 2010.

North Dakota-Puerto Rico psychiatrist Enrique Rivera-Mass guilty of prescribing over Internet

On October 27, 2010, psychiatrist Enrique Rivera Mass signed an agreement with federal prosecutors to plead guilty to a charged of conspiracy to distribute a controlled substance.

[Note: Rivera Mass is identified as a child and adolescent psychiatrist on the websites Psych Yellow Pages, San Juan Doctors andVitals.]

Mass became involved with Internet prescribing while in his native Puerto Rico and continued to do so while employed at the Center for Psychiatric Care in Grand Forks, North Dakota between January 2007 and April 2009.

Authorities report that Mass signed off on prescriptions for nearly 1.8 million pills—weight loss drug phentermine, tranquilizers, painkiller and the smoking cessation drug Chantix—issuing prescriptions to customers in almost every state though he did not meet or talk to any “patients” or have access to their medical records prior to approving the prescriptions.  (Examinations, medical/social/treatment histories and the like are part of the standard of care for physicians.)

Mass now faces a maximum of 10 years in prison and the surrender of $100,000 in profits when he is sentenced April 15, 2011.  He also had his North Dakota medical license revoked.

Source: Dave Kolpack, “Former North Dakota doctor signs plea agreement in Internet prescription fraud case,” Canadian Business, October 27, 2010.

Psychiatrist Edmundo Chirinos sentenced to 20 years prison for murder of patient

On September 29, 2010, psychiatrist Edmundo Chirinos, of Caracas, Venezuela, was sentenced to 20 years in prison for the murder of a young woman who was his patient.

Chirinos was convicted of killing 19-year-old Roxana Vargas, whose body was found in 2008 with a blow to the head in a park on the outskirts of Caracas.

The attorney general’s office stated that investigators found approximately 1,200 photographs of nude female patients in Chirinos’ home.  The attorney general has accused him of drugging the women and abusing them.

Source: “Venezuelan psychiatrist sentenced in slaying,” Associated Press, September 29, 2010.

 

Anna Nicole’s psychiatrist convicted by jury on four felony drug conspiracy charges

A boyfriend and two doctors who were part of Anna Nicole Smith’s inner circle in her final days and were charged with enabling her prescription drug use were acquitted of most drug charges Thursday, but two were convicted of conspiring to use false names to get her prescriptions.

Howard K. Stern, Smith’s boyfriend-lawyer, and Dr. Khristine Eroshevich, her psychiatrist, were convicted of conspiring to get the former Playboy model and reality TV star painkillers and sedatives.

Prosecutors contended during the nine-week trial that the defendants were dazzled by Smith’s glamor and filled her demands for prescription drugs to protect their insider status in her personal life and her celebrity world.

Defense attorneys countered by portraying the defendants as angels of mercy who were trying to help Smith cope with her chronic pain, particularly after she gave birth to her daughter by cesarean then quickly lost her 20-year-old son, Daniel, to a drug overdose.

Smith eventually died of an accidental drug overdose in Florida in 2007, but the defendants were not charged in her death at age 39.

The jury convicted Stern of conspiring with Eroshevich to obtain drugs through the use of a false name and misrepresentation. Eroshevich also was found guilty of using a false name and misrepresentation to obtain prescriptions for the painkiller Vicodin for Smith.

Dr. Sandeep Kapoor, the physician who prescribed most of her pain medications, was acquitted of all charges in a verdict he called a triumph for the medical profession.

“This is not just a victory for me, but for patients everywhere who suffer chronic pain,” an emotional Kapoor said outside court.

His lawyer Ellyn Garofalo said it also was a victory for Smith.

“The jury found she was not an addict,” Garofalo said.

Stern originally faced 11 counts of conspiracy, excessive prescribing of opiates and sedatives to an addict, and fraudulently obtaining drugs by using false names but was convicted of only two conspiracy counts. The judge previously dismissed two charges against him.

As he left the courthouse, Stern told reporters, “Everything relating to the appropriateness of the medication, I was acquitted of.”

His lawyer, Steve Sadow, said Stern never denied using his name on Smith’s prescriptions but maintained Stern didn’t know it was illegal.

Stern, 41, had been Smith’s lawyer, manager, lover and friend since they met in 2001. Testimony showed they were inseparable, even when she was involved with other men.

In 2006, Smith donned a wedding gown, and she and Stern had a commitment ceremony on a catamaran off the Bahamas. They exchanged rings and vows but were never legally married.

At one point, Stern claimed he was the father of Smith’s baby daughter until DNA tests made clear the father was photographer Larry Birkhead, who now has custody of the child.

“Prosecutors contended during the nine-week trial that the defendants were dazzled by Smith’s glamor and filled her demands for prescription drugs to protect their insider status in her personal life and her celebrity world.”

Sadow contended during the trial that Smith was the love of Stern’s life and he would never harm her. He also stressed that Stern was not a doctor and was relying on medical professionals to do the right thing for Smith.

Kapoor and Eroshevich also were close to Smith during her final years.

Eroshevich, 63, was Smith’s neighbor and friend before treating her as a psychiatrist. Prosecutors claimed the friendship was a violation of professional ethics and called a pharmacist who testified the amount of drugs Eroshevich requested for Smith at one point would have amounted to pharmaceutical suicide.

The pharmacist refused to fill the request, and prosecutors showed Eroshevich used other pharmacies to get most of the drugs and took them to Smith in the Bahamas.

Along with conspiracy, Eroshevich was convicted of unlawfully obtaining Vicodin by fraud. The jury deadlocked on whether she unlawfully prescribed the drug.

“I feel relieved,” Eroshevich said. “I’m just happy it’s over.”

Her attorney, Brad Brunon, said he would likely move for a new trial and might ask to have the charges against her reduced to misdemeanors.

Stern and Eroshevich remained free pending a Jan. 6 hearing when the defense can file a motion for a new trial.

If the motion is denied, the judge can sentence both defendants, but it was not immediately clear how much prison time, if any, they could face.

Kapoor, 42, who was Smith’s internist, wrote numerous prescriptions for opiates and sedatives during the period he treated her. His lawyer said he followed a drug regimen originated by Smith’s previous doctor who sold his practice to Kapoor.

Prosecutors Renee Rose and David Barkhurst argued that Kapoor blurred the line between patient and doctor when he was photographed kissing her at a party. They also pointed to a diary in which Kapoor discussed the “mesmerizing” experience of riding with her in a gay pride parade and wondered: “Can she ruin me?”

The jury of six women and six men spent nine weeks hearing details of Smith’s troubled life and 58 hours deliberating their verdicts.

Dave Kettel, a former federal prosecutor who handled prescription drug cases and was in court for the verdicts, said the outcome might make authorities reluctant to file similar cases.

Prosecutors who handled the case said they would have no comment because the defendants still had to be sentenced.

Los Angeles County District Attorney Steve Cooley said in a written statement he was pleased there were some guilty verdicts.

“This case illustrates the problem of the overuse of prescription medicine in today’s society,” said Cooley, a candidate for state attorney general. “Medical professionals have a responsibility to ensure that the strict ethical guidelines of their profession are followed in prescribing medicine as part of the care of their patients.”

Citizens Commission on Human Rights prepared an excellent report on this subject (which Eroshevich probably should have read a long time ago): When Prescribing Psychotropic Drugs Becomes Criminal Negligence

Source: “Psychiatrist, lawyer convicted in Smith drug case,” Associated Press, October 28, 2010.

New Hampshire psychiatrist Lawrence Mazur gives up license permanently; “imminent danger” to patients

A New Hampshire psychiatrist who was suspended for alleged misconduct at Lakes Regoinal General Hospital in Laconia has agreed to surrender his license.

The New Hampshire Board of Medicine said Friday it accepted the permanent, voluntary surrender from 62-year-old Lawrence Mazur.

Mazur acknowledged his action “has occurred in settlement of pending disciplinary charges.”

Lakes Region General Hospital suspended Mazur on June 22 and the board of medicine ordered an emergency suspension of his license on June 30, citing “imminent danger to life and health” of his patients.

A hospital worker complained that Mazur had assaulted her by repeatedly pushing her away from a patient she was trying to help. She filed a restraining order against him.

Mazur has not been charged with any crime.

Source: “NH psychiatrist surrenders license,” Boston Herald, October 23, 2010.

Bam! Feds arrest top mental health clinic execs in $200 million Medicare fraud investigation

Even by Miami-Dade’s reputation for Medicare fraud, the indictment was a shocker:

American Therapeutic’s patients could not feed themselves or control their own bodily waste.

Many lacked the mental capacity to respond to counseling; instead they simply stared at walls or watched TV.

An employee complained that those patients should be ineligible for Medicare since they could not benefit from treatment.

She got fired.

That launched whistle-blower and criminal investigations that led to the Justice Department’s takedown Thursday of Miami-based American Therapeutic Corp., the nation’s largest chain of mental health clinics.

Federal prosecutors charged the company and four top executives with scheming to fleece $200 million from the taxpayer-funded healthcare program.

“Some of the patients were not even cognizant of where they were or what was going on around them,” said Lanny A. Breuer, assistant attorney general of Justice’s criminal division.

“Other patients were simply there to make money, through kickbacks,” said Breuer, who flew to Miami for a news conference at the U.S. attorney’s office.

At the crack of dawn Thursday, federal agents arrested Lawrence S. Duran, 48, of North Miami, the owner of American Therapeutic; Marianella Valera, 39, the company’s CEO; Margarita Acevedo, 40, the firm’s marketing director; and Judith Negron, 39, vice president of a subsidiary.

Since 2003, Medicare paid the chain a total of $84 million—taxpayer money that authorities say was mostly blown on luxury items, including Duran’s 2009 Maserati Quattroporte and Valera’s bayfront condo at the Opera Towers. Duran and Valera also spent the money on trips to Switzerland, Dominican Republic and Cuba.

The feds obtained court orders to freeze the employees’ personal and corporate bank accounts in an attempt to salvage possibly a few million dollars of the Medicare payments.

The indictment charged American Therapeutic, a seven-clinic chain, and its subsidiary, Medlink Professional Management Group, Inc., and the four employees with conspiring to defraud Medicare for group therapy sessions that were either unnecessary or not provided to patients, many suffering from Alzheimer’s or dementia.

The ring is also accused of paying bribes to recruiters who tapped into an endless supply of patients from assisted-living facilities and halfway houses, who also received kickbacks for the referrals.

The accused ringleaders, Duran and Valera, instructed doctors and employees to alter patient charts, medical diagnoses, therapy session notes and drug medications to make American Therapeutic’s thousands of claims look legitimate to Medicare, according to court documents.

Whether they harmed any patients is the subject of “an ongoing investigation,” Breuer and other Justice Department officials said.

On Thursday morning, 160 agents from the FBI and Health and Human Services raided American Therapeutic’s clinics at 1801 NE Second Ave. and other South Florida locations. They carried out boxes of records, computers and other evidence and loaded them into vans. Patients who showed up for their daily mental health sessions were asked to leave.

IN COURT

Later Thursday, in federal court, the four defendants had their first appearance. They were dressed in Euro-style T-shirts and pants — though they were cuffed at the wrists and ankles.

Jennifer Saulino, a Justice Department attorney, recommended no bond for Duran and Valera and $1 million bail for Negron and Acevedo.

“This was the largest Medicare fraud scheme in this district, and, as you know, Your Honor, that’s saying quite a lot,” she told Magistrate Judge Edwin Torres. “This was a big fraud, and these were big players.”

Acevedo was granted a $350,000 bond. The other three will have pretrial detention hearings on Tuesday.

The scope of South Florida’s alleged $200 million case surpassed that of a vast network of Armenian gangsters and their associates charged last week with operating phantom healthcare clinics to try to cheat the federal program out of $163 million.

U.S. authorities touted that case as “the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise,” with 73 people charged in New York, Los Angeles and other cities.

The Miami indictment signaled the Justice Department’s latest assault against rampant Medicare fraud in South Florida.

U.S. Attorney Wifredo Ferrer called mental health fraud the latest scam in a series involving medical equipment, HIV infusion and home diabetic services.

Authorities said the magnitude of such fraud is eye-opening: More than 100 Florida mental health centers, mostly in Miami-Dade, submitted $425 million in bills to the Medicare program last year.

In turn, Medicare paid $171 million to the Florida clinics, with almost all of that money going to mental health operators—such as American Therapeutic—in Miami-Dade, Broward and Palm Beach counties.

Indeed, reimbursements to South Florida clinics alone accounted for 56 percent of Medicare’s entire payments to mental health centers nationwide last year, according to the agency’s records.

American Therapeutic is not only Medicare’s highest biller of mental health services in the country, but Duran also has been active in a Washington, D.C., lobbying group called The National Association for Behavioral Health.

A video of Duran’s visit in January to the congressional office of U.S. Rep. Ileana Ros-Lehtinen, R-Miami, was posted on You Tube, in which he talked about protecting mental health services under the healthcare reform legislation passed by Congress this year.

Also, Duran and two other South Florida healthcare businessmen were pictured with the congresswoman in a photo posted on the Behavioral Health’s website.

Confronted with an onslaught of suspicious claims, Medicare administrators began placing many suspect Miami-Dade mental health clinics on what is known as “prepayment review.”

That means payments are frozen until Medicare can verify that doctors prescribed the services, the clinics provided the counseling sessions, and patients received and benefited from them.

Without confirmation, the clinics aren’t paid, which has led to some shutting down.

BILLIONS IN LOSSES

Although Medicare under the Obama administration has improved technology to weed out fraudulent claims, the agency still loses billions of dollars yearly to fraud because it generally pays bills quickly without verifying them.

Medicare officials issued a statement Thursday, applauding the Justice Department’s crackdown and their joint efforts to stop the crisis.

“It is clear the administration is not only stepping up law enforcement activities to crack down on criminals,” the statement said, “but is becoming much more committed to preventing fraud in the first place.”

Source: Jay Weaver, “Mental health clinics targeted in Medicare fraud crackdown,” Miami Herald, October 22, 2010

Psychiatrist Joel S. Dreyer blames holes in his brain for his unlawful prescribing

Brett Siciliano drove home to San Clemente from the Riverside Federal Courthouse on Tuesday morning, disappointed once again. A small urn with his twin sister’s ashes hung from his neck.

The man he blames for the death of his sister, Jessica Silva, at her Newport Coast home was scheduled to be sentenced to prison for giving out Xanax and OxyContin prescriptions for $100, among other things.

As he has done several times in the year since he pleaded guilty, Joel Stanley Dreyer got a delay in his sentencing again, this time until Dec. 13, by firing his lawyer and arguing that he had brain damage. Three holes in his frontal lobe affect his sense of smell and judgment, he’s told the court.

The federal prosecutor handling the case, Antoine Raphael, said Dreyer may try to back out of a plea agreement at another hearing Nov. 29.

Siciliano, 41, came ready to give a victim impact statement, to have his say at last. But the letdown, he said, “sucked the life out of me.”

Siciliano isn’t just a grieving brother waiting for justice from others. He launched an investigation that helped lead to Dreyer’s arrest.

Prosecutors cited Siciliano’s independent investigation in court filings.

Court records link Dreyer not just to Silva, but to Brandon Keating, a 25-year-old who died in a Costa Mesa detox facility in 2007. Dreyer, who lost his psychiatry license this year, was charged with distributing around 150,000 pills of Oxycontin, Xanax, Vicodin, and other often-abused drugs.

He was also accused of taking part in a conspiracy to illegally supply prescription drugs to a Tijuana pharmacy.

For Siciliano, it started Christmas Day, 2005.

He was outside Jessica Silva’s condo, pounding on the door.

Silva hadn’t shown up for Christmas with the family, even though it was likely to be the last one they’d have with their ailing grandmother. Nobody had heard from her in two days.

Although Siciliano had been clean for three years, his sister was still struggling with pills. So Siciliano went to check on her. He could hear her Maltese, Princess, inside barking, but there was no answer at the door.

He called the Newport Beach police, who broke a window to let them all in. Silva was lying motionless on the bed, Princess whimpering by her side.

The coroner’s office would determine that the 35-year-old divorced saleswoman had died two days earlier. Police found more than 20 prescription medications in the house; 10 of them were found in her blood, stomach and liver.

Siciliano noticed that a prescription for 90 Oxycontin pills – filled three weeks before – had been written by Dreyer, raising his suspicion.

“My grandma was dying of cancer and she couldn’t even get a prescription for one OxyContin,” Siciliano said. “When I Googled (Dreyer) and found out he was a psychiatrist, I knew. Psychiatrists don’t give Oxy. They give Viagra, Lipitor.”

The coroner’s office ruled that Silva’s death was caused by a reaction between Oxy and four other drugs.

Siciliano, a former real estate agent and current board game entrepreneur, started trying to set up an appointment with Dreyer.

“He’d say, ‘Call me in a month, call me in month,'” Siciliano said Monday.

Siciliano never mentioned his sister’s name, but he said Dreyer seemed wary.

“After about nine months of calling him, and him saying he wasn’t taking any more patients,” Dreyer relented on Siciliano’s last attempt before giving up.

On Nov. 14, 2006, Siciliano visited Dreyer at his Murrieta office, complained of back, neck, and knee pain, and got prescriptions for Norco, Vicodin, and Ambien, according to court records.

“This doctor had a hole in the wall sharing it with the chiropractor,” Siciliano said. “There were strung-out patients in the waiting room. I got eight years in recovery, so I know the look. He told me not to go to the corner Walgreens” to fill the prescriptions.

Siciliano filled the prescriptions, and drove to the Murrieta Police Department, where he met Det. John Nelson.

“I went there with my mother, my sister’s dog, and my sister’s ashes,” Siciliano recalled.

Siciliano dumped out the pills on the detective’s desk. He showed Nelson the coroner’s report of his sister’s death, and gave him receipts for his sister’s drug purchases.

“I’m here to tell you about this Dr. Joel Dreyer,” Siciliano remembered saying.

“Oh, you mean this guy,” Nelson responded, pulling out a file Siciliano remembers as four inches thick.

Local patrol officers had been pulling over young people and finding drugs prescribed by Dreyer for some time, Siciliano remembers the detective telling him.

Over the next several months, undercover investigators from the police, the Drug Enforcement Administration, and California Medical Board wore wires to meet with Dreyer, according to court records.

Dreyer asked no questions about medical history, conducted no examinations, generally asked what drug the patient was interested in, and then suggested a symptom, according to records. He charged $100 for the visits and wrote a prescription for each investigator.

Dreyer was charged in federal court in Feb. 2008, and pleaded guilty on Sept. 21 2009. At his plea hearing, he offered a rambling defense.

“I was humanitarian of the year in Michigan in 1984…. I’m just not this bad guy I’m being painted out to be…. I have brain damage. I have three holes in the frontal lobe of my brain… Two things happen. You can look it up on the computer. Lack of sense of smell….and a lack of judgment. So… I saw patients I didn’t know, probably, everything they were telling me, your honor, saw patients in pizza parlors. But did I know the drugs were being delivered on the street? No. Did I make any profit off of it? No…. Did I do a physical exam? No. I haven’t done a physical exam since 1963.”

This August, Dreyer was stripped of his medical license.

Shortly before his arrest, according to published reports, he had been fired from his job as a staff psychiatrist at Oak Grove Institute, a residential treatment center and school for children with problem behavior.

On New Year’s Day, 2006, Brett Siciliano, his mother Hedy Porr, and others buried Jessica Silva. It was her birthday.

For his family, Siciliano said, the holidays are forever changed. One image is burned in his mind.

“There was a little toddler upstairs opening a Christmas present, as they brought my sister out in a body bag.”

Source: Jon Cassidy, “Sister’s drug death launches man’s quest for justice,” Orange County Register, October 5, 2010.

Psychiatrist admits to lying to FBI; pays $830K to settle fraud case and will be sentenced in January

St. Louis psychiatrist Howard Goldstein pleaded guilty Tuesday and admitted to lying to an FBI agent about making false Medicare billings.

Missouri Attorney General Chris Koster said Goldstein engaged in “upcoding,” a scam whereby he would bill Medicaid for more work than he actually performed. Goldstein, for example, would spend five minutes or less with a patient and then bill Medicaid for a 20-minute session, Koster said.

Goldstein also agreed to pay $830,329 to the United States in a related civil settlement agreement and be excluded from participation in the Medicare program for a period of five years.

In a separate civil settlement agreement, Goldstein’s former employer, SSM St. Charles Clinic Medical Group Inc. and SSM Healthcare Corp. agreed to reimburse the United States an additional $865,812 for Goldstein’s false charges to Medicare, bringing the total civil recovery from the investigation to nearly $1.7 million.

Missouri will receive $176,748 of the $441,870 Medicaid portion of the settlements as its share based on the federal and state joint funding of the Medicaid program, Koster said.

The federal felony charge of making a false statement to an agent of the Federal Bureau of Investigation stemmed from an April 2010 interview in which Goldstein minimized and mischaracterized concerns and problems that had been raised by SSM.

In his plea agreement, Goldstein admitted that between January and June of 2007, the hospital audited his Medicare claims, finding that the medical records created to document the services that Goldstein had billed to Medicare were scant and illegible, raising serious problems, the U.S. attorney’s office said. SSM considered firing Goldstein but decided to allow him to remain employed while requiring attendance at a Medicare coding education session, prosecutors said.

But later, in March 2009, a peer physician review of Goldstein’s billings revealed more problems, prompting SSM to contact the government and the FBI to launch an investigation.

Goldstein, 53, formerly of Clayton, now faces a fine of up to $30,000 and a forfeiture of $100,000 under a plea agreement when he is sentenced Jan. 5, 2011.

Source: “St. Louis psychiatrist admits lying to FBI in Medicare probe,” St. Louis Business Journal, October 12, 2010.

State upholds suspension of psychologist Samuelle Klein-von Reiche; appeal fails

On September 1, 2010, the Superior Court of New Jersey, Appellate Division (“Court”) upheld the November 30, 2009 decision of the New Jersey State Board of Psychological Examiners (“Board”) who suspended the license of Samuelle Klein-von Reiche (“Reiche”).

On February 4, 2008, the Attorney General charged Reiche with multiple counts of violating appropriate boundaries between a therapist and a client; endangering the health welfare and safety of a patient; repeated acts of negligence; failure to fulfill the ongoing statutory requirements of good moral character; gross malpractice; misuse of influence as a therapist; use or employment of dishonesty, fraud, deception, misrepresentation and false pretense; and the failure to cooperate with an inquiry of the Board.

Reiche developed an inappropriately close, personal and social relationship with a patient.  At the patient’s expense, Reiche accompanied the patient to a professional convention in the Bahamas between September 19 and 24, 2004, shared a hotel room with him for several nights, and dined together on at least two occasions.  In addition, Reiche discussed intimate details of her personal life with the patient.

During the investigation by the Board, Reiche was uncooperative with the Board and misrepresented facts in the case.  The Board issued a one-year suspension of the Respondent’s license, a $5,000 penalty plus the costs of the hearing.

Source: In the Matter of the Suspension of Revocation of License of Samuelle Klein-von Reiche, Psy.D., License No. 35SI00324600 to Practice Psychology in the State of New Jersey.

More Texas mental health counselors disciplined

On July 23, 2010, the Texas Department of State Health Services issued the following disciplinary actions:

Licensed professional counselor ALISON KUNEFKE was placed on one year probation suspension for failing to set and maintain professional boundaries.  Kunefke entered into a dual relationship with a client and engaged in personal and sexual relation with a client.

Licensed professional counselor MARION LEE KIRK was placed on one year probated suspension for failing to set and maintain professional boundaries.  Kirk entered into a dual relationship with a client.

Licensed professional counselor PETER BRADLEY was assessed a $500 administrative penalty for having supervised licensed professional counselors when he did not possess a Texas Department of State Health Services approved license to do so.

Licensed professional counselor CYNTHIA BOYD voluntarily surrendered her license on allegations of failing to set and maintain professional boundaries.  She entered into a dual relationship with a client.

Licensed professional counselor STEVE W. SPOHR was placed on 18 months probated suspension for reasons related to his criminal history.