By Christopher P. Young, Editor, G2 Compliance Advisor
A Brookline Massachusetts physician, Dr. Punyamurtula Kishore, and his company Preventive Medicine Associates, Inc. (PMA), pleaded guilty to fraudulently billing Massachusetts’s Medicaid program, MassHealth, for unnecessary drug tests. Kishore was sentenced to 11 months in jail and he and PMA were ordered to pay $9.3 million after pleading guilty to Medicaid kickbacks, Medicaid false claims (for PMA) and larceny over $250 (for PMA and Kishore). Kishore also agreed to surrender his medical license.
Kishore owned a statewide chain of drug treatment clinics and a clinical laboratory both of which provided urine drug testing services for facilities known as sober houses. According to Massachusetts Attorney General Maura Healey’s April 7 announcement, Kishore paid bribes and kickbacks to sober house owners and managers to induce them to send urine samples to his laboratory for drug tests. State regulations require a medical determination that the tests are necessary and the provider making the determination must be physically present and actively involved in treating the patient. According to Healey’s announcement, Kishore and PMA used the names of PMA physicians and nurse practitioners that had never seen the patients or made any kind of determination of medical necessity. Sober house residents were tested as many as three per week yielding between $100 and $200 per screen, adding up to millions of dollars paid by MassHealth to Kishore and PMA.
Also previously pleading guilty in the case are Damion Smith, 42, president of Fresh Start Recovery Coalition who made his plea in June of 2012 and Carl Smith, 69, manager of New Horizon House who pled guilty in January. Both were sentenced to two-year suspended prison terms and two years of probation. Cases against two other sober house managers are still ongoing.
This case was brought to the attorney general by MassHealth and is another example of the more aggressive pursuit of Medicaid fraudsters. Laboratory compliance officers must make note of this higher level of enforcement by state Medicaid programs and make sure they understand how the programs work in their state.
Also of interest is the number of different state and federal agencies involved in the investigation of Kishore and PMA. This is another demonstration of increased cooperation between state and federal enforcement agencies in detecting and prosecuting fraud.