13 indicted in Metro Detroit health care fraud, drug distribution scheme
Metro Detroit doctors, pharmacists and home health agency owner face charges in alleged fraud scheme
Thirteen new defendants and a variety of new charges have been added to an indictment originally returned in August 2011, which charged Canton Township pharmacist Babubhai "Bob" Patel with overseeing a health care fraud and drug distribution ring at the 21-plus pharmacies he owned and controlled in and around Detroit.
Read more: Detroit-area pharmacy owner, 5 others convicted of drug fraud after 6-week trial
The U.S. Attorney's Office says the 21-count indictment alleges that Patel was the beneficial owner and controller of approximately 26 pharmacies statewide. According to the indictment, Patel would offer and provide kickbacks, bribes and other illegal benefits to physicians to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance, and to direct that those prescriptions be presented to one of the Patel Pharmacies for billing.
In exchange for their kickbacks and inducements, the physicians would write prescriptions for the patients, and bill the relevant insurers for services supposedly provided to the patients, without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of Patel's pharmacies. There, according to the indictment, Patel and his pharmacists would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and, in many cases, never provided.
According to the U.S. Attorney's Office, patients were recruited into the scheme by patient recruiters or "marketers," who would pay kickbacks and bribes to patients in exchange for the patients' permitting Patel's pharmacies -- and the physicians associated with Patel -- to bill their insurance for medications and services that were medically unnecessary and/or never provided.
Pharmacies accused of submitting false claims
The indictment further alleges a conspiracy to distribute controlled substances at Patel's pharmacies, a purpose of which was to facilitate the submission of false and fraudulent claims to Medicare, Medicaid and private insurers in accordance with the scheme outlined above, the U.S. Attorney's Office says.
According to the indictment, Patel and his associates paid physicians associated with the scheme kickbacks and other inducements in exchange for the medical professionals writing prescriptions for controlled substances for their patients, and directing those patients to fill the prescriptions at a Patel pharmacy. The controlled substances involved included the Schedule II drug oxycodone (Oxycontin), the Schedule III drug hydrocodone (Vicodin, Lortab) the Schedule IV drug alprazolam (Xanax), and the Schedule V drug cough syrup with codeine.
According to the indictment, prescriptions for these drugs were written outside the course of legitimate medical practice. Patel and his pharmacists would then dispense the controlled drugs to patients without medical necessity. The distribution of controlled substances in this manner was intended, in part, as a kickback to the patients for agreeing to enable their insurance cards to be billed for medications purportedly dispensed at the Patel pharmacies.
Pharmacies accused of giving 'marketers' kickbacks for recruitment
The indictment also alleges that Patel and his pharmacists dispensed controlled substances outside the scope of legitimate medical practice to patient recruiters or “marketers,” as a kickback for their efforts in to recruit patients into the scheme.
In addition to his pharmacies, the indictment alleges that Patel had an ownership interest in a home health agency managed by his brother, Vinod Patel. The indictment alleges that Vinod Patel, Babubhai Patel and others bribed physicians and other referral sources for referrals to that home health agency, and then billed the Medicare program for home health services that were medically unnecessary and never provided.
The 13 defendants named in the indictment are the following:
-- Pharmacist Mehul Patel, 34, of Canton Township
-- Pharmacist Pradeep Pandya, 49, of Grand Blanc
-- Pharmacist Vikas Sharma, 34, of Windsor
-- Pharmacist Mukesh Khunt, 33, of Toronto
-- Physician Richard Utarnachitt, 71, of Clinton Township
-- Physician Ruben Benito, 72, of Madison Heights
-- Physician Javaid Bashir, 59, of Jackson
-- Physician Carl Fowler, 60, of West Bloomfield
-- Physician Rajat Daniel, 47, of West Bloomfield
-- Home health agency owner Vinod Patel, 40, of Canton Township
-- Business associate Atul Patel, 31, of Canton Township
-- Marketer Anthony Macklin, a.k.a. "Jimbo," of Detroit
-- Marketer Michael Thoran, a.k.a. “Ace,” also of Detroit
DEA agents raid medical office buildings in Commerce Township, Clinton Township
The DEA executed federal search warrants at medical offices in Commerce Township and Clinton Township Tuesday morning in connection with the prescription drug fraud investigation.