Now imagine if the state actually went after Medicaid fraud in child welfare.
Mass. AG allege Medicaid fraud schemes cost $10M
BOSTON (AP) — Massachusetts Attorney General Martha Coakley announced indictments Friday against 10 people linked to a series of Medicaid fraud schemes that investigators say cheated taxpayers out of nearly $10 million.
The allegations included billing the state for care provided to dead patients, kickback schemes for unnecessary drug tests and claiming nursing home residents needed help walking and eating when they were able to do both on their own. In each case, investigators said the goal was to bilk MassHealth, the state's Medicaid program.
A total of 118 criminal indictments against 10 individuals have been handed down in the four cases.
Coakley said the indictments were returned Thursday by three grand juries including a special statewide grand jury and are the result of four major criminal investigations by the state Medicaid Fraud unit.
Coakley said the kind of fraud alleged in the indictments ultimately forces up health care costs for everyone in Massachusetts.
"It's like when people are shoplifting in a store, it's passed onto consumers," Coakley said Friday. "They might as well be walking over to MassHealth and taking money out of the state treasury."
The cases involved four private health care providers: Adlife Healthcare; Preventative Medicine Associates; Mitchell Counseling Services; and Wetterberg Nursing Homes, which ran the Pond View Nursing Facility in Boston.
In the case of Adlife, investigators allege that owner Sharon Richardson, 55, of Framingham and two employees billed MassHealth for approximately $5.5 million in services that were not provided.
Adlife is a group adult foster care provider for MassHealth with locations in Framingham, West Springfield, Boston and Hyannis.
Investigators' allege Adlife billed MassHealth for treating deceased individuals and individuals who never received services. Richardson is also accused of falsifying records submitted to MassHealth and working with two employees to destroy internal records to cover up the fraud.
Richardson was arrested Thursday. Her lawyer, Michael Stromsnes, declined comment.
The second set of indictments focus on a Brookline doctor, Punyamurtula Kishore, 61, and his company Preventative Medicine Associates, Inc., with 29 locations statewide.
Investigators said Kishore and three others orchestrated an elaborate drug screening kickback scheme and fraudulently billed MassHealth for nearly $3.8 million.
Coakley's office said Kishore used bribes to induce various so-called "sober homes" to send patients to his laboratories to perform unnecessary urine drug screens — as many as three a week — that were later billed to Medicaid. Investigators said drug screens are generally billed at between $100 and $200 each and Kishore billed MassHealth for tens of thousands of the tests.
Three managers or owners of the "sober homes" — New Horizon House in Boston, Marshall House in Malden and Gianna's House, which operates homes in Wareham, New Bedford and Sandwich — were also indicted.
Kishore was arraigned Wednesday in Malden District Court and later released after surrendering his passport.
Kishore's attorney said Kishore is "an extremely well-regarded member of the community" who denies the allegations.
The third alleged scheme defrauded MassHealth of $160,000 and involved David Benson, 48 of New Bedford and his company Mitchell Counseling Services.
Investigators said Benson, an independent clinical social worker, routinely billed for treatment that exceeded services provided to six patients. Coakley's office said Benson billed as if his patients were in need of acute care multiple times a week when they were being provided minimal care or no care at all.
A call to Mitchell Counseling Services wasn't answered Friday.
The final investigation resulted in an indictment against Carolyn Wetterberg, 70, of Weymouth for allegedly billing MassHealth more than $600,000 for services not provided.
Wetterberg was part owner and sole manager of Wetterberg Nursing Homes, Inc., which ran the Pond View Nursing Facility in the Jamaica Plain neighborhood of Boston. The 43-bed long term care facility was shut down by the Massachusetts Department of Public Health in June for poor quality of care.
Coakley's office said Wetterberg defrauded MassHealth by deliberately overstating the level of disabilities of those who lived in the facility, allowing her to bill for more than their care required.
Investigators said in some cases patients she claimed needed help walking were walking independently and those she claimed needed help eating were eating on their own.
A man who answered the phone at Wetterberg's home said she wasn't available for comment.
ReplyDeleteMAD DOG MILLIONAIRE a.k.a. Punyamurtula Kishore MD, is a QUACK.
Punyamurtula S. Kishore, M.D a.k.a. MAD DOG MILLIONAIRE HAS BEEN SUSPENDED
Massachusetts Board Discipline.This section includes final disciplinary actions taken by the Board.
Date4/9/2014Case #2014-014Action Summary Suspension.
Date9/19/2012Case #2010-025Action Reprimand, Fine, Continuing Medical Education, Community Service Instrument Final Decision and Order Fine $2,500.00
MAD DOG MILLIONAIRE aka PUNYAMURTULA KISHORE MD TRIAL DATE Nov. 11, 2014
Punyamurtula Kishore, M.D. and three other defendants will go on trial on Nov.11, 2014 , 2014
MAD DOG MILLIONAIRE a.k.a. Punyamurtula Kishore MD, Patients Die of Improper Care Protocols!!!!
Many of Dr. Punyamurtula Kishore’s patients have died because of improper treatment and care methods. This Quack doctor (“Hitler”of Medical Geoncide) should not be allowed to practice medicine anywhere. Preventive Medicine Associates, formerly Addiction medicine Associates was a Death Camp (The Holocaust for Drug Addicts and Alcoholics, “Auschwitz” in Brookline, MA) I worked at his Brookline office and witness the death of many patients. Dr. Kishore should be arrested, arraigned and prosecuted for 1st. degree murder or manslaughter.
Dr. Punyamurtula Kishore was reprimanded, fined $2,500 and required to perform 50 hours of Board-approved community service and to complete additional continuing professional development credits. He was found to have inappropriately filed four Temporary Involuntary Hospitalization Applications for the purpose of drug treatment and drug testing. Dr. Kishore is a 1975 graduate of Andhra Medical College in India. He specializes in Addiction Medicine and has NOT been licensed in Massachusetts TO PRACTICE Addiction medicine !!!!!!!!!!!!!
MAD DOG aka PUNYAMURTULA KISHORE MD 2020 TRIAL DATE Nov. 11, 2014
Punyamurtula Kishore, M.D. and three other defendants will go on trial on Nov.11, 2014 2014 for allegedly bilking MassHealth of almost $20 million, in what Coakley’s office calls an “intricate scheme” involving drug testing, sober homes, and his Preventive Medicine Associates (PMA).
According to Coakley, Kishore used various bribes or kickbacks to persuade sober house owners to require residents to submit urine tests at least three times per week. The tests were performed by PMA’s office laboratories, then billed to MassHealth, which pays $100 to $200 for such screens. Also charged in the case were Carl Smith, manager of New Horizon House, John Coughlin, president of Gianna’s House, and Thomas Leonard, part owner and manager of Marshall House—all for receiving kickbacks.
MAD DOG a.k.a Punymurtula Kidhore MD and Lil Dog a.k.a. Carl Smith L.M.H.C. are responsible for the death of Eleanor Clark of Weston , Massachusetts.
Just look at what happen to James Clark .
James Clark was a client at the same address where the Director/Manager Carl Smith resided at ,50 Draper Street in Dorchester MA. Carl Smith is suppose to be a state licensed Mental Health Clinician , If so , than why did he discharge James Clark ? James clark never tested postive for a toxicology screen for illegal or prescription drugs, than why was he discharged ?
He was discharged for behavioral and attitude problems that were related to his psychiatric and substance abuse diagnosis. Carl Smith L.M.H.C. should have been able to detect that this man had psychological problems and referred him for treatment to MAD DOG aka Punyamurtula K…ishore’s Neurological Clinic for treatment and to help James Clark get back on his psychiatric medication. Instead , Carl Smith discharged him and the following day , James Clark murdered his 81 year old grandmother Eleanor Clark in Weston Massachusetts .
Punyamurtula Kishore MD aka MAD DOG Millionaire referred James Clark to Carl Smith’s Program New Horizon House after James Clark was Discharged from St. Elizabeths Hospital’s S.E.C.A.P.’s Detoxification unit.
Punyamurtula Kishore MD a.k.a. MAD DOG MILLIONAIRE , Brookline Doctor Pleads Guilty, Sentenced to Jail and Ordered to Pay $9.3 Million for Running
ReplyDeleteMedicaid Kickback and False Billing Scheme
Punyamurtula Kishore MD a.k.a. MAD DOG MILLIONAIRE to Surrender Medical License, Sentenced to House of Correction
BOSTON – A Brookline doctor has pleaded guilty, was
sentenced to jail, and has been ordered to pay $9.3 million in
restitution for running an intricate Medicaid fraud scheme involving
millions of dollars in taxpayer funds, Attorney General Maura Healey
announced today.
Dr. Punyamurtula Kishore, 64, along with his company Preventive
Medicine Associates, Inc. (PMA), pleaded guilty on Monday in Suffolk
Superior Court. PMA pleaded guilty to charges of Medicaid Kickbacks (8
counts), Medicaid False Claims (19 counts) and Larceny over $250 (11
counts). Dr. Kishore pleaded guilty to one count of Larceny over $250.
“Dr. Kishore orchestrated a complex kickback scheme to funnel a
lucrative drug screening business to his laboratories and then billed
taxpayers millions of dollars for those services,” AG Healey said. “This
case exhibited blatant theft of state funds that were supposed to go
toward care for some of our most vulnerable residents. This is fraud
that undermines the integrity of our health care system.”
Today, Superior Court Judge Janet Sanders sentenced Kishore to 360
days in the House of Correction, with 11 months to serve and the balance
suspended for 10 years. As a condition to his sentence, Kishore has
also agreed to surrender his medical license. Judge Sanders also ordered
Kishore and PMA to pay, jointly and severally, a total of $9.3 million
in restitution.
Dr. Kishore previously owned and managed PMA, a network of 29 medical
branches throughout Massachusetts, including physician office
laboratories and one independent clinical laboratory. Based on the AG’s
investigation, Dr. Kishore used bribes, or kickbacks, to induce sober
house owners to send their residents’ urine drug screening business to
his laboratories for testing. Residents were typically screened three
times per week.
A urine drug screen may be billed to MassHealth by a physician if the
screen is medically necessary. Drug screens generally are billed to the
MassHealth program for approximately $100 to $200. Dr. Kishore
manipulated his business relationships with sober house owners to
illegally obtain tens of thousands of drug screens paid for by
MassHealth for sober house residents who were never treated by PMA
providers.
In September 2011, Dr. Kishore and PMA were indicted,
and individually charged with Medicaid Kickbacks (8 counts), and
Medicaid False Claims (8 counts). In November 2013, Dr. Kishore and PMA
were indicted on additional charges of Medicaid False Claims (11 counts)
and Larceny over $250 (11 counts) for billing MassHealth for millions
of dollars in drug screens using the names of PMA physicians and nurse
practitioners who were not actually treating the patients or determining
the drug screens to be medically necessary. State regulations require
that the services must be medically necessary and the provider must be
physically present and actively involved in the treatment of the
member.
Carl Smith L.M.H.C. aka Lil Dog, New Horizon House
ReplyDeleteCarl Smith L.M.H.C. aka Lil Dog, New Horizon House
Carl Smith, the 65-year-old manager of New Horizon House LLC, has been charged with participating in a fraudulent drug-screening operation. Arraigned on Friday, he pleaded not guilty and is being held on $30,000 bail. He is due back in Suffolk Superior Court on Oct. 14.
According to a court filing from the attorney general’s office, Smith has a “lengthy criminal record” dating back to 1975 when he was convicted of armed robbery. He was sentenced to three to five years in state prison. He was convicted of rape of young boys in1979 and 1989. He is a pedophile and registered level 1 sex offender.
He was also convicted of kidnapping and armed robbery in 1979, larceny in 1989, forgery and embezzlement in 1991, forgery and larceny in 1994, and possession of a hypodermic needle or syringe in 1995, the filing noted.
Carl Smith’s indictment was one of 118 brought by Coakley through a statewide grand jury and others in Suffolk and Bristol counties. The alleged scheme involves three health care companies, ten individuals, and $10 million fraudulently obtained, largely from the state Medicaid program.
State Rep. Marty Walsh, who attended the Port Norfolk meeting, said he was troubled by the allegations. “I question what kind of program he’s actually running there,” he said. “If he’s defrauding the government, is he defrauding the clients as well and not providing them with services?”
Describing four unrelated cases, state prosecutors said Adlife Healthcare of Framingham allegedly billed the state for medical treatment to people who were deceased. Preventive Medicine Associates, and its owner, Dr. Punyamurtula Kishore, of Brookline, allegedly ran a “kickback scheme” with sober houses throughout the state.
Smith is accused of getting paid $34,000 in return for arranging the ordering of urine drug screening tests for which MassHealth paid Kishore and PMA more than $786,000.
Punyamurtula Kishore MD a.k.a. MAD DOG MILLIONAIRE , Brookline Doctor Pleads Guilty, Sentenced to Jail and Ordered to Pay $9.3 Million for Running
ReplyDeleteMedicaid Kickback and False Billing Scheme
Punyamurtula Kishore MD a.k.a. MAD DOG MILLIONAIRE to Surrender Medical License, Sentenced to House of Correction
BOSTON – A Brookline doctor has pleaded guilty, was
sentenced to jail, and has been ordered to pay $9.3 million in
restitution for running an intricate Medicaid fraud scheme involving
millions of dollars in taxpayer funds, Attorney General Maura Healey
announced today.
Dr. Punyamurtula Kishore, 64, along with his company Preventive
Medicine Associates, Inc. (PMA), pleaded guilty on Monday in Suffolk
Superior Court. PMA pleaded guilty to charges of Medicaid Kickbacks (8
counts), Medicaid False Claims (19 counts) and Larceny over $250 (11
counts). Dr. Kishore pleaded guilty to one count of Larceny over $250.
“Dr. Kishore orchestrated a complex kickback scheme to funnel a
lucrative drug screening business to his laboratories and then billed
taxpayers millions of dollars for those services,” AG Healey said. “This
case exhibited blatant theft of state funds that were supposed to go
toward care for some of our most vulnerable residents. This is fraud
that undermines the integrity of our health care system.”
Today, Superior Court Judge Janet Sanders sentenced Kishore to 360
days in the House of Correction, with 11 months to serve and the balance
suspended for 10 years. As a condition to his sentence, Kishore has
also agreed to surrender his medical license. Judge Sanders also ordered
Kishore and PMA to pay, jointly and severally, a total of $9.3 million
in restitution.
Dr. Kishore previously owned and managed PMA, a network of 29 medical
branches throughout Massachusetts, including physician office
laboratories and one independent clinical laboratory. Based on the AG’s
investigation, Dr. Kishore used bribes, or kickbacks, to induce sober
house owners to send their residents’ urine drug screening business to
his laboratories for testing. Residents were typically screened three
times per week.
A urine drug screen may be billed to MassHealth by a physician if the
screen is medically necessary. Drug screens generally are billed to the
MassHealth program for approximately $100 to $200. Dr. Kishore
manipulated his business relationships with sober house owners to
illegally obtain tens of thousands of drug screens paid for by
MassHealth for sober house residents who were never treated by PMA
providers.
In September 2011, Dr. Kishore and PMA were indicted,
and individually charged with Medicaid Kickbacks (8 counts), and
Medicaid False Claims (8 counts). In November 2013, Dr. Kishore and PMA
were indicted on additional charges of Medicaid False Claims (11 counts)
and Larceny over $250 (11 counts) for billing MassHealth for millions
of dollars in drug screens using the names of PMA physicians and nurse
practitioners who were not actually treating the patients or determining
the drug screens to be medically necessary. State regulations require
that the services must be medically necessary and the provider must be
physically present and actively involved in the treatment of the
member.
Punyamurtula Kishore MD a.k.a. MAD DOG MILLIONAIRE , Brookline Doctor Pleads Guilty, Sentenced to Jail and Ordered to Pay $9.3 Million for Running
ReplyDeleteMedicaid Kickback and False Billing Scheme
Punyamurtula Kishore MD a.k.a. MAD DOG MILLIONAIRE to Surrender Medical License, Sentenced to House of Correction
BOSTON – A Brookline doctor has pleaded guilty, was
sentenced to jail, and has been ordered to pay $9.3 million in
restitution for running an intricate Medicaid fraud scheme involving
millions of dollars in taxpayer funds, Attorney General Maura Healey
announced today.
Dr. Punyamurtula Kishore, 64, along with his company Preventive
Medicine Associates, Inc. (PMA), pleaded guilty on Monday in Suffolk
Superior Court. PMA pleaded guilty to charges of Medicaid Kickbacks (8
counts), Medicaid False Claims (19 counts) and Larceny over $250 (11
counts). Dr. Kishore pleaded guilty to one count of Larceny over $250.
“Dr. Kishore orchestrated a complex kickback scheme to funnel a
lucrative drug screening business to his laboratories and then billed
taxpayers millions of dollars for those services,” AG Healey said. “This
case exhibited blatant theft of state funds that were supposed to go
toward care for some of our most vulnerable residents. This is fraud
that undermines the integrity of our health care system.”
Today, Superior Court Judge Janet Sanders sentenced Kishore to 360
days in the House of Correction, with 11 months to serve and the balance
suspended for 10 years. As a condition to his sentence, Kishore has
also agreed to surrender his medical license. Judge Sanders also ordered
Kishore and PMA to pay, jointly and severally, a total of $9.3 million
in restitution.
Dr. Kishore previously owned and managed PMA, a network of 29 medical
branches throughout Massachusetts, including physician office
laboratories and one independent clinical laboratory. Based on the AG’s
investigation, Dr. Kishore used bribes, or kickbacks, to induce sober
house owners to send their residents’ urine drug screening business to
his laboratories for testing. Residents were typically screened three
times per week.
A urine drug screen may be billed to MassHealth by a physician if the
screen is medically necessary. Drug screens generally are billed to the
MassHealth program for approximately $100 to $200. Dr. Kishore
manipulated his business relationships with sober house owners to
illegally obtain tens of thousands of drug screens paid for by
MassHealth for sober house residents who were never treated by PMA
providers.
In September 2011, Dr. Kishore and PMA were indicted,
and individually charged with Medicaid Kickbacks (8 counts), and
Medicaid False Claims (8 counts). In November 2013, Dr. Kishore and PMA
were indicted on additional charges of Medicaid False Claims (11 counts)
and Larceny over $250 (11 counts) for billing MassHealth for millions
of dollars in drug screens using the names of PMA physicians and nurse
practitioners who were not actually treating the patients or determining
the drug screens to be medically necessary. State regulations require
that the services must be medically necessary and the provider must be
physically present and actively involved in the treatment of the
member.