White Collar Criminal Defense Group

DOJ Opioid Fraud Unit Gets First Indictment

What Happened?

The Department of Justice’s new opioid fraud unit unsealed its first indictment last week, targeting a Pittsburgh-area physician in a 14-count indictment alleging unlawful distribution of controlled substances and conspiracy.

The Rundown

In August, Attorney General Jeff Sessions announced the creation of the Opioid Fraud and Abuse Detection Unit chartered to target 12 federal districts hardest hit by the opioid epidemic. The unit uses data analytics to identify and investigate physicians and medical providers who are overprescribing opioids as well as pharmacists failing to properly distribute them.  The 12 districts on which the opioid unit is focused include the Western District of Pennsylvania, Southern District of West Virginia, and Southern District of Ohio.

The indictment filed last week was the product of the new opioid unit and alleges that a local physician, Andrzej Zielke, wrote prescriptions for oxycodone, hydrocodone, and methadone at least 13 times that were “not for medical purposes.” It was also alleged that Dr. Zielke charged patients $250 cash, many of whom traveled long distances for opioid prescriptions.

Federal regulations – specifically, 21 C.F.R. § 1306.04(a) – require prescriptions, including those for opioids, to be issued only for “a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.”  Doctors disregarding this requirement have led federal agents and prosecutors to increasingly focus on alleged overprescribing, particularly those who exhibit “red flags“ like cash only medical practices, lack of physical exams, prescribing without using opioid monitoring databases, prescribing dangerous combinations of drugs, prescribing to known addicts, and directing patients to use pharmacies known for lax dispensing practices.

For the Record

Acting U.S. Attorney Soo Song: “Western Pennsylvania is experiencing some of the highest rates of overdose deaths in the nation.  In response, we in law enforcement aggressively target drug traffickers – both those who distribute on the street, and those who traffic under the guise of physicians writing excessive prescriptions.”               

Attorney General Jeff Sessions: “This summer, I designated a dozen of our top federal prosecutors to focus solely on the problem of opioid-related health care fraud in places where the epidemic was at its worst – including Western Pennsylvania. …Today, as President Trump unveils his plan to fight the opioid epidemic, we have filed the first charges by these prosecutors.  We will file many more charges in the months to come – because the Department of Justice will be relentless in hunting down drug dealers and turning the tide of this epidemic.”

What Happens Next?

There are no pending court appearances for Dr. Zielke, whose case is assigned to District Court Judge Nora Barry Fischer. 

If you are a doctor in the Pittsburgh regions and you become the subject of an investigation regarding your medical practice, please do not hesitate to contact one of our Attorneys today.

NJ Doctor Pleads Guilty To Health Care Fraud

What Happened

The healthcare fraud enforcement efforts of the U.S. Attorney’s Office for the District of New Jersey continue. Anthony J. Enrico, 60, of North Haledon, New Jersey pleaded guilty on October 17, 2017 to an information charging him with health care fraud. Enrico admittedly billed Medicare and other health insurance providers for physical therapy services that he had reported to have performed on his patients’ between January 2007 and May 2016.

The Rundown 

Enrico billed Medicare and private insurance companies for physical therapies he did not perform or were performed by individuals that were uncertified or unlicensed on more than 150,000 occasions. As a result, he managed to collect close to $3 million from the government and private insurance companies alike, which ultimately gained the attention of the Health Care and Government Fraud Unit, the department of Health and Human Services, and the FBI. Enrico faces a maximum penalty of 10 years in prison, a fine of up to twice the amount of the loss, as well as payment for restitution totaling $3 million. His sentencing will take place on January 25, 2018.

The Take Home

The Health Care and Government Fraud Unit of the U.S. Attorney’s Office for the District of New Jersey has been working diligently since 2010 to crackdown on health care fraud throughout the state. Created by the U.S. Attorney’s Office for the District of New Jersey to handle both criminal and civil investigations and prosecutions of health care fraud offenses, they have recovered more than $1.36 billion in various health care and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug and Cosmetic Act, and other statutes. There are no signs of its aggressive enforcement efforts letting up.