Physician Guilty of Medicare Fraud Put Patients at Risk

January 18, 2012

January 18, 2012 — A stiff prison sentence handed down to a physician in Los Angeles, California, last week for his role in a massive Medicare scam highlights how a seeming burlesque of medicine posed a danger to patients.

Alexander Popov, MD, was sentenced to 8 years and 1 month in prison in a federal court in Sacramento, California, after a jury last year found him guilty of conspiring to — and committing — healthcare fraud. An indictment issued in 2010 stated that Dr. Popov and 4 other physicians allowed a man named Vardges Egiazarian, who owned 3 clinics in the California cities of Carmichael, Richmond, and Sacramento, to submit Medicare claims in their names. Dr. Popov took on the role of co-owner and practitioner at the Sacramento clinic but never saw a patient there, according to federal prosecutors.

Over the course of 2 and a half years, Dr. Popov and the other physicians submitted more than $5 million worth of bogus claims to Medicare for nonexistent or unnecessary services, of which they received $1.7 million. The physicians' share of the take was 20% of what was paid out under their Medicare provider number.

In a sentencing memo filed in the case, federal prosecutors credit Dr. Popov and the other conspirators with doing "everything necessary to establish and operate a health clinic, with the exception of actual healthcare." As part of their hustle, they paid "cappers" to recruit and transport patients to the clinics, and the patients themselves received $100 each for showing up — a kind of reverse copay.

The patients, who were predominantly elderly immigrants who did not speak English, received little if any medical care during their visits. Clinic employees nevertheless recorded in their charts that they had received a comprehensive exam and a broad array of diagnostic tests. Staff would plug in off-the-shelf test results or would run tests on themselves and use those numbers. Dr. Popov, who lived in Los Angeles, saw none of these patients in person, but signed the charts anyway, according to prosecutors.

Trampling the Hippocratic Oath "On the Way to the Bank"

Prosecutors sought, and received, a 97-month prison sentence for Dr. Popov partly on the basis of how this sham practice of medicine "recklessly ignored the risk of death or physical harm to...patients."

For example, 1 patient chart that Dr. Popov signed contained legitimate test results showing that the patient had a huge abdominal mass and abnormal creatinine levels. Yet there is no indication in the chart that Dr. Popov or anyone else followed up with the patient about these dire findings, according to the federal sentencing memo. In such instances, prosecutors said, patients who mistakenly rely on phony medical care forego receiving actual care.

Patients also ran other risks to their physical well-being. One unsupervised clinic employee performed blood draws without a license to do so, and a standing order for all patients with hypertension to receive clonidine went against sound medical practice, according to the sentencing memo.

Another physician charged in the case, Emilio Cruz III, MD, awaits trial, according to prosecutors. Seven other members of the scheme, including Derrick Johnson, MD, have pled guilty. All await sentencing except for Vardges Egiazarian, who is serving a 78-month prison sentence.

Prosecutors noted that although Egiazarian was the leader of the conspiracy, Dr. Popov deserved a longer sentence. Unlike Egiazarian, Dr. Popov did not plead guilty, thus necessitating an expensive trial. Prosecutors also noted that he fabricated evidence and lied on the witness stand. Yet another reason for the longer sentence is that Dr. Popov abused his position of trust.

"Egiazarian is no doctor subject to an oath to do no harm," prosecutors write. "Certainly what he did was reprehensible, what each of the defendants did was.

"But there is a special place in this case for doctors who work under the Hippocratic oath and who trample that oath on their way to the bank."

US District Judge Morrison England Jr, who sentenced Dr. Popov on January 12, agreed with that reasoning.

"A physician," England told the court, "should be held to a higher standard, rather than a lower standard."

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