What Happens to Physicians Charged with Healthcare Fraud?
Doctors under investigation will often ask, what am I facing? We can outline the actual statutory penalties but in real life what actually happens to doctors charged with healthcare fraud? We looked at some cases to see.
In 2019 the Department of Justice announced the filing of 10 healthcare fraud cases. Here is what they announced.
Medicare Fraud Charges in California:
Defendants:
- Dr. Ronald Weaver, 70, Pacific Palisades
- Sara Soulati, 49, Santa Monica
- Dr. John Weaver, 75, Alhambra
- Dr. Ronald Carlish, 78, Pacific Palisades
- Dr. Howard Elkin, 68, Whittier
- Dr. Wolfgang Scheele, 79, Los Angeles
- Dr. Nagesh Shetty, 74, Huntington Beach
These individuals are charged with participating in a $135 million Medicare fraud scheme involving unnecessary cardiac treatments and testing through Global Cardio Care of Inglewood. The case is being prosecuted by DOJ Trial Attorneys Emily Z. Culbertson and Alexandra Michael.
Additional Charges:
- Navid Vahedi, 40, Los Angeles
- Fusion Rx Compounding Pharmacy
- Joseph S. Kieffer, 39, Los Angeles
Vahedi and Kieffer are accused of a fraud and kickback scheme involving commissions to marketers and patients for unnecessary compounded drugs, resulting in $17 million in losses. They allegedly used gift cards to cover patient copayments to avoid detection. Vahedi reportedly purchased a 1963 Ford Mustang Cobra with the proceeds.
Related Case:
- Joshua Pearson, 40, St. George, Utah
Pearson is charged with receiving illegal kickbacks for patient referrals. The cases are being prosecuted by Assistant U.S. Attorneys Ashwin Janakiram, Alexander Schwab, and Jonathan Galatzan.
California Medicaid Fraud Charges:
Defendants:
- Hilda Haroutunian, 59, Sun Valley
- Dr. Keyvan Amirikhorheh, 60, Seal Beach
- Lorraine Watson, 56, Physician’s Assistant, Valley Village
- Noem Sarkisyan, 63, North Hollywood
- Edmond Sarkisyan, 40, Medical Assistant, North Hollywood
These individuals are charged with a $10 million scheme to defraud the Family Planning, Access, Care and Treatment (Family PACT) program administered by Medi-Cal. They allegedly submitted fraudulent claims for family planning services, testing, and prescriptions for non-existent patients through Los Angeles Community Clinic and associated diagnostic testing laboratories and pharmacies. The case is being prosecuted by DOJ Trial Attorney Alexis D. Gregorian1.
Additional Charges:
- Amir Friedman, 54, Anesthesiologist, Calabasas
Friedman is charged with conspiracy to commit honest services mail and wire fraud and Travel Act violations involving $800,000 in kickbacks for compounded pharmaceutical drugs through New Age Pharmaceuticals, Inc., in Beverly Hills. The case is being prosecuted by Assistant U.S. Attorney Ashwin Janakiram2.
Related Case:
- Susan H. Poon, 54, Chiropractor, Dana Point
Poon is charged with a $2 million scheme to defraud Anthem, Aetna, and other Blue Cross Blue Shield Association affiliates. She allegedly submitted false claims for chiropractic services, medical diagnoses, and office visits that never occurred, as well as fraudulent prescriptions for durable medical equipment. The case is being prosecuted by Assistant U.S. Attorney Daniel S. Lim of the Santa Ana Branch Office.
California Health Care Fraud Charges:
Defendants:
- Antonio Olivera, 78, Downey
- Emelita Cephass, 57, Downey
- Martin Canter, 70, Rancho Palos Verdes
These individuals are charged with participating in a hospice kickback scheme involving Mhiramarc Management LLC, a hospice in Downey. Olivera is also charged with defrauding Medicare. In a separate case, hospice owner John O’Brien is charged with health care fraud conspiracy. The cases are being prosecuted by DOJ Trial Attorney Justin P. Givens.
Additional Charges:
- Mahyar David Yadidi, 37, Chiropractor, Los Angeles
Yadidi is charged with conspiracy to commit health care fraud, defrauding the International Longshore and Warehouse Union – Pacific Maritime Association (ILWU-PMA) health care benefit plan through his clinic, San Pedro Philips Chiropractic. He allegedly offered kickbacks to patients and billed for services not rendered or medically unnecessary, involving unlicensed employees. Co-defendants Ivan Semerdjiev, 40, Irvine, and Julian Williams, 44, San Pedro, are also charged. They allegedly submitted nearly $5 million in fraudulent claims. The case is being prosecuted by Assistant U.S. Attorney Alex Wyman.
Related Case:
- Darren Hines, 49, Chiropractor, Harbor City, Los Angeles
Hines is charged with health care fraud for defrauding the ILWU-PMA plan through his clinic, Advanced Alternative Health. He allegedly billed for services not rendered and used unlicensed employees, submitting over $500,000 in fraudulent claims. The case is being prosecuted by Assistant U.S. Attorney Alex Wyman.
Source: See DOJ Press Release on Healthcare Fraud Arrests
Medical Board and Federal Court Website Search Results
But what is the status of these doctors who were charged with healthcare fraud five years ago? We went to the Medical Board of California license lookup page and checked on some of the names.
Current Status of Doctors Charged with Healthcare Fraud Five Years Ago:
We checked the Medical Board of California license lookup page for updates on these doctors:
- Dr. Ronald Weaver: License renewed and current. Criminal case pending trial.
- Dr. John Weaver: License renewed and current. Criminal case pending trial.
- Dr. Ronald Carlish: License delinquent; renewal fee unpaid. No practice permitted. Criminal case pending trial.
- Dr. Howard Elkin: License renewed and current. Criminal case pending trial.
- Dr. Wolfgang Scheele: License renewed and current. Criminal case pending trial.
- Dr. Keyvan Amirikhorheh: License surrendered on May 16, 2023. Court case: Judge Andre Birotte Jr. sentenced Amirikhorheh to six months in prison, followed by 12 months of home detention and three years of supervised release. Restitution of $4,366,018 ordered, jointly liable with co-defendants. Remaining counts dismissed. Surrender date: May 2, 2022.
- Dr. Amir Friedman: License revoked. Court case: Judge John F. Walter sentenced Friedman to 14 months in prison and two years of supervised release. Special assessment of $100. Surrender date: April 18, 2022.
Both convicted doctors accepted plea deals. Those proceeding to trial face the risk of higher sentences.
Restoration of Medical Licenses After Felony Healthcare Fraud Convictions
Restoring a medical license after a felony healthcare fraud conviction is a challenging process. Federal convictions are not subject to the “clean slate” laws available in many states. In California, while a felony conviction can be expunged, licensing is not entirely barred. However, federal convictions remain on record, and it is uncertain if the California Medical Board will treat an open federal conviction the same as a sealed state conviction regarding licensing.
A federal healthcare fraud conviction prevents a doctor from receiving compensation from any federal source, such as Medicare. This raises the question: how can a doctor practice without Medicare reimbursement? While niche practices might be an option, they often operate under the radar. Here’s what the law states about convicted physicians:
Given California’s focus on rehabilitation, renewing a medical license is not impossible. Suspended or revoked doctors should keep their continuing education up-to-date, meeting the requirements for maintaining their medical license and any board certifications. Discussing other post-conviction conduct and rehabilitation efforts with a medical license attorney is crucial.
Loss of Medicare Enrollment
42 CFR § 424.542 Prohibition on ordering, certifying, referring, or prescribing based on felony conviction.
(a) General prohibition. A physician or other eligible professional (regardless of whether he or she is or was enrolled in Medicare) who has had a felony conviction within the previous 10 years that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries may not order, refer, certify, or prescribe Medicare-covered services, items, or drugs.
(b) Payment. Medicare does not pay for any otherwise covered service, item, or drug that is ordered, referred, certified, or prescribed by a physician or other eligible professional (as that term is defined in section 1848(k)(3)(B) of the Act) who has had a felony conviction within the previous 10 years that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries.
Expert Legal Defense for Healthcare Fraud Charges
Facing healthcare fraud charges?
Our team of highly experienced, board-certified criminal defense specialists is here to help. We also have physician experts who can assist in renewing your medical license after a conviction. For healthcare fraud cases, you need a lawyer who specializes in criminal law and medical license law. Daniel Horowitz is one of the few true experts in this field.