Pain Center Physicians Acquitted of $500 million Healthcare Fraud Allegations

After a seven week trial in the Eastern District of Michigan, four physicians were acquitted of allegations that they unlawfully prescribed opiates and performed unnecessary interventional pain treatments on patients in the Detroit metropolitan area. Dr. David Lewis, one of the four physicians, was led in his defense by attorneys Ron Chapman of the Chapman Law Group and Jeffrey Collins.

Dr. David lewis and three other physicians were fully acquitted after allegations of $450 million in healthcare fraud

Three years ago, the Government alleged that these doctors — Bothra, Edu, Lewis, and Russo — bilked Medicare, Medicaid, Blue Cross Blue Shield and other insurers by prescribing powerful opioid painkillers to swindle patients into receiving expensive and unnecessary back injections. Dr. Bothra, owner of the clinic at the center of these indictments, sat in custody for 48 months during the entirety of the COVID-19 pandemic patiently awaiting trial.

Two other physicians, Dr. Backos and Kufner, plead guilty, waiving their right to a trial and choosing to take the stand for the Government.

Seven weeks’ worth of trial commenced for an attentive, notes-taking jury. Seven weeks of presentations by a Government which seemed entirely too concerned with the physicians’ unapologetic popularity rather than their sworn, and now proven, duty to provide legitimate patient care.

On the morning of June 29, 2022, this diligent Detroit jury rendered its verdict:

Not guilty on all counts.

Health Care Fraud and Unlawful Prescribing

Healthcare fraud requires the Government to prove that a physician “knowingly and intentionally” devised a scheme or artifice to defraud a federal healthcare program. Typically this is proven when providers bill for services not rendered, or “upcode” the services rendered to receive additional compensation. To convict a physician of “unlawful prescribing” or running a “pill mill”, the Government must prove that the physician prescribed outside the usual course of professional practice for other than a legitimate medical purpose. This was a standard clarified in a recent Supreme Court decision handed down the day of deliberations in the Pain Center case.

Here the Government alleged that the physicians utilized opioid painkillers such as Hydrocodone to “hook” patients on the pain meds and then coerce patients to undergo unnecessary injections in order to continue to receive pain treatment. The jury didn’t buy it.

The seven week healthcare fraud trial

At trial, the Government provided over five weeks of testimony from investigators, patients, employees of the practice and an expert witness, Dr. Neel Mehta. Their goal was a lofty one, as they were tasked with proving that four board-certified interventional pain physicians violated their oath and prescribed unnecessary back injections and opioids to patients who “didn’t need or want them”.

Lacking from the Government’s case, as Attorney Ron Chapman II pointed out during closing argument, was a complete analysis of the patient population to prove that the physicians engaged in a pattern of unlawful conduct. Chapman also pointed out the improper standard utilized by the Government’s experts and investigators which sought to convict the physicians in what amounts to a mere difference of medical opinion.

The expert witness called by the Government, Dr. Mehta, reviewed only six charts of pain patients who received treatment. From this review the Government suggested that the clinic was rife with fraudulent conduct. As Ron Chapman pointed out during closing arguments, this is inappropriate and inconsistent with Medicare policies that require a valid statistical sample, proper review, and provider education before determining that claims to the Medicare program are maliciously false.

On the defense side, patients of the practice were called and testified that they received excellent care. The defense also called three physicians as expert witnesses to testify to the suitability of care rendered, as well as a coding and billing expert.

Two of the defendants, Dr. David Lewis and Dr. Gainu Edu chose to testify in their own defense and provided unimpeached testimony that the care they rendered was legitimate and necessary to treat the patients medical needs.

Acquitted on All Counts of Healthcare Fraud and Unlawful Prescribing

At the conclusion of these seven grueling weeks, the jury deliberated for just ten hours before reaching a verdict on Wednesday June 29, 2022.

Dr. Bothra, who has been incarcerated for over three years by an order of the Sixth Circuit Court of appeals, was released. Drs Lewis, Edu, and Russo are also now free from the weight of a federal indictment.

Subscribe and stay tuned to Federal Defense Blog for a deep dive into the strategy in the case and an analysis of how statistical sampling was used to successfully defend this indictment.