Tennessee Doctor Charged with Massive Opioid Fraud Scheme
Posted on December 16, 2018 by Medtech[y] Staff
A 45-count federal indictment was unsealed yesterday, charging Dr. Samson Orusa, 56, of Clarksville, Tennessee with maintaining a drug-involved premises; 22 counts of unlawful distribution of a controlled substance outside the bounds of professional medical practice; 13 counts of healthcare fraud; and nine counts of money laundering, announced U.S. Attorney Don Cochran for the Middle District of Tennessee.
Orusa was arrested by federal agents yesterday and appeared before a U.S. Magistrate Judge late in the afternoon.
“Physicians who prey upon an already addicted population; steal from public healthcare programs; and engage in such reckless disregard for patient safety, as alleged here, will face a vigorous prosecution by this office,” said U.S. Attorney Cochran. “Anyone who contributes to the opioid epidemic plaguing this nation should expect to be targeted by our law enforcement partners and held accountable.”
According to the indictment, as early as January 2014, Orusa opened and maintained his medical practice at 261 Stone Crossing Drive in Clarksville, Tennessee for the purpose of distributing Schedule II controlled substances, including oxycodone, not for legitimate medical purposes and beyond the bounds of medical practice. The indictment alleges a pattern of conduct by Orusa whereby patients were prescribed oxycodone and other Schedule II controlled substances without obtaining the patient’s prior medical history; performing a credible physical examination or performing a diagnostic workup.
In one such instance, the indictment alleges that in February 2015, Orusa diagnosed a patient with Chronic Pain Syndrome without performing a specific examination and prescribed oxymorphone (an opioid), Soma (carisoprodol, a muscle relaxer), and alprazolam (benzodiazepine, an anti-anxiety drug). This regimen is commonly referred to as “The Holy Trinity,” and is considered to be a potentially deadly drug cocktail. On February 24, 2015, this patient died as a result of ingesting a like combination of drugs. The indictment also alleges that on April 17, 2018, a patient suffered a heroin overdose in the waiting room of Orusa’s medical office after Orusa prescribed oxycodone and other Schedule II controlled substances, without conducting proper examinations or checking the patient’s medical history. Other patterns of conduct alleged in the indictment include Orusa prescribing oxycodone to patients identified as high risk and to patients with questionable and falsified drug screens. Between July 1, 2018, and August 21, 2018, the indictment alleges that Orusa wrote approximately 2,494 prescriptions for Schedule II controlled substances.
The indictment further alleges that on September 14, 2018, the State of Tennessee permanently revoked Orusa’s Pain Management Certificate and on that same day, Orusa wrote 164 individual prescriptions for approximately 12,754 Schedule II controlled substance pills. Beginning in 2014, several pharmacies in Montgomery County, Tennessee refused to honor prescriptions for Schedule II controlled substances written by Orusa.
The indictment also alleges that beginning in 2014, Orusa devised and participated in a scheme to defraud health insurance benefit providers, including Medicare, by submitting upcoded reimbursement claims to Medicare, indicating a higher level of service than actually performed; submitting false and fraudulent claims to Medicare for services that were medically unnecessary; causing claims to be submitted to Medicare for prescriptions that were issued in violation of law or otherwise outside the bounds of accepted medical practice; and diverting proceeds of the fraud.
The allegations include as part of the scheme, that Orusa would accept or see 50-60 patients or more in a single day; require insurance patients, including Medicare beneficiaries, to visit his office approximately four to six times in a single month in order to increase and inflate reimbursement claims, while cash paying patients were only required to visit Orusa’s office twice per month; and required insurance patients, including Medicare beneficiaries, to accept injections, in order to increase and inflate reimbursement claims. Orusa threatened to withhold pain management prescriptions from insurance patients who refused the injections. Cash paying patients, however, generally were not required to accept injections in order to receive pain management prescriptions.
Finally, the indictment alleges that Orusa conducted financial transactions designed to disguise the nature of the unlawful activity and that he transferred or caused to be transferred, proceeds of the unlawful activity to foreign bank accounts; used clinic proceeds to make a $12,451.00 down payment on a 2017 Mercedez-Benz; and wrote a check for the purchase of $100,000 in securities.
“The arrest of Dr. Orusa should serve as a warning to all doctors who fail to practice medicine in an ethical and responsible manner,” said D. Christopher Evans, Special Agent In Charge of DEA’s Louisville Field Division, which oversees DEA activity throughout Kentucky, Tennessee and West Virginia. “The men and women of DEA are committed to using every available resource to stop the flow of drugs into our communities, especially when the drug dealer is a physician,” Evans added.
“The opioid epidemic impacts families in every community,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Physicians who overprescribe opioids should recognize they are contributing to the cycle of abuse, addiction and overdose that too often ends in death.”
“Illegally prescribing narcotics for profit is a serious offense,” stated Matthew D. Line, Special Agent in Charge of the IRS-Criminal Investigation. “This investigation should send a message to operators of these illegal pill mills that this activity will be investigated and prosecuted. IRS Criminal Investigation is proud to work with our law enforcement partners to stop the flow of these illegal drugs into our communities.”