With some much political and public pressure on opioids, you would think that so called “pill mills” would have long ago disappeared. On January 30, 2019, however, a Florida doctor was sentenced to prison for running an illegal pill mill. Dr. Jayam Krisna Iyer was sentenced to six months for her role in a Medicare fraud scheme involving fentanyl, oxycodone and morphine. Prosecutors say she was allowing some patients to obtain their drugs without the required face to face doctor visit.
Iyer began practicing medicine in 1982. She was a licensed physician who operated a pain management clinic in Clearwater, Florida. Like many states, Florida has strict rules regarding the dispensing of controlled substances including narcotic pain killers. These rules require a physician to perform a complete history and examination during every visit in which controlled substances were prescribed.
Prosecutors say that beginning in 2011, Dr. Iyer began dispensing narcotics to patients who did not come into the office and who she had not visited face to face.
To hide the scheme in case she was audited, Iyer falsified records to make it appear that her patients were seen in the office. These phony records would include her phantom patient’s blood pressure, pulse, weight and temperature.
Often the prescriptions were handed to family members and sometimes even friends of the patient instead of the patients themselves. Some of these prescriptions were for very potent – and frequently abused – pain killers such as morphine and oxycodone.
Prosecutors say that Dr. Iyer was charged in 2000 for intent to distribute oxycodone for prescribing narcotics without a legitimate medical purpose and outside the scope of her medical practice. That charge was dropped from her record after she successfully complete a first offender diversion program.
Eleven years later she was charged again, that time with federal healthcare fraud. She was acquitted of those charges.
According to an affidavit we obtained, the FBI and Department of Health and Human Services handled the 2011 investigation. A special agent said under oath that Dr. Michael Spuza was convicted of Medicare fraud and excluded from the Medicare program for ten years. Patients, however, said that they continued to be seen by Dr. Spuza but Medicare was billed as if the patient was seen by Jayam Iyer.
Patients were told that Dr. Iyer couldn’t write prescriptions because of her DEA suspension.
The agent concluded that Dr. Iyer was billing Medicare as if she saw the patients (she didn’t) while Dr. Spuza was dispensing narcotics to her patients. The arrangement was ingenuous although not necessarily legal. One doctor was barred from dispensing drugs while the other was barred from billing Medicare patients.
In 2018, the current charges were filed. To her credit, Dr. Iyer accepted responsibility and immediately entered a guilty plea.
Outside her lengthy history with the courts, the DEA separately suspended Dr. Iyer’s ability to dispense prescription drugs in 2006. The agency determined that she was dispensing narcotics without the required to face-to-face patient visit. Her ability to write prescriptions was later restored.
One patient was prescribed highly addictive morphine, oxycodone, oxycontin, Roxicodone, Percocets, methadone along with 60 valiums. Another patient was prescribed fentanyl.
In certain instances, these prescriptions may be entirely legitimate. A cancer patient suffering break out pain may have a need for fentanyl. But how can the physician know the patient’s needs when the patient is nowhere to be found? How can you justify handing out a methadone prescription to the “friend” of the patient instead of the patient himself? The answer is, you can’t. And the law in most states says the patient must be examined face to face by the doctor before receiving a prescription for a narcotic.
Because of these factors, the Justice Department asked for the maximum prison sentence under the federal sentencing guidelines.
Dr. Iyer asked the court for a light sentence. In arguing for minimal or no jail, she claimed that she is the sole caregiver for her ailing husband. She also said that she “led a life marked by devotion of extensive time, effort and financial resources to a litany of noble cause and the betterment of human lives through a blend of spiritual guidance and western medicine.”
The latter claim is quite puzzling. While we applaud people who donate to charity, her income clearly came from defrauding Medicare meaning taxpayers. This almost smacks of the “Robin Hood” defense except instead of stealing from the rich and giving to the poor, one can argue that Jayam Iyer stole from everyone and gave to the charities of her choice.
We also don’t see how human lives are bettered through illegal peddling of dangerous narcotics.
The court saw fit to hand down a light sentence of six months but also ordered her to surrender her medical license. She can re-apply to the DEA to be able to write prescriptions in 20 years. Given that she is 66, that probably isn’t much of a risk.
The Justice Department says it is still pursuing civil recoveries against Dr. Iyer. Under the federal and Florida False Claims Act, Jayam Iyer is subject to triple damages and penalties as high as $20,000 for each improper prescription submitted to Medicare and Medicaid.
We like the False Claims Act because whistleblowers who report healthcare fraud can receive between 15% and 30% of whatever monies the government collects from the wrongdoers.
Whistleblowers with inside information about fraud involving taxpayer funded healthcare (Medicare, Medicaid or Tricare) are eligible for cash rewards for stepping forward and reporting misconduct. To qualify for an award, you must file a sealed complaint in court. While the matter is under investigation it is sealed meaning the physician, clinic or hospital doesn’t know the whistleblower’s identity.
Ultimately, the government must intervene and take over the case, ask the court for the case to be dismissed or let the whistleblower’s own lawyer prosecute privately.
There are strong provisions in the law that address illegal whistleblower retaliation.
We are currently interested in speaking with nurses and employees of pain management clinics with knowledge of widespread, frequent dispensing of narcotics without face to face doctor visits. You may be eligible for a large cash reward if those visits are paid for by Medicare, Tricare or Medicaid. In Illinois and California, payment by any insurance company may qualify for an award.
This case was investigated by the government’s Opioid Fraud and Abuse Detection Unit, a multi-agency effort involving the Department of Justice, FBI and Health and Human Services special agents.