Insurance Fraud NEWS
Office visits done by unlicensed employee in New Hampshire
September 17, 2018, Windham, NH
A Windham nurse practitioner pleaded guilty in U.S. District Court on Monday to health care and prescription fraud.
Kristen Khanna, 42, a nurse practitioner licensed to practice in New Hampshire, operated Total Pain Care and Wellness, PA in Salem from October 2009 until December 2015.
The charges focus on 2014 and 2015, when Khanna was the only licensed provider at Total Pain Care. The government’s investigation, which included interviews with patients, a review of prescribing data and other investigative techniques, revealed that Khanna was often not present at Total Pain Care and allowed office visits to be conducted by an unlicensed employee, according to U.S. Attorney Scott Murray, whose office prosecuted the case.
On numerous occasions, Khanna would bill Medicare for those visits as if she had conducted them, causing Medicare to reimburse Total Pain Care for the services purportedly rendered, Murray said.
Medicare would not have paid for these sham office visits if it had known that the employee and not Khanna was providing the service, Murray noted.
Khanna also admitted that she would often leave the employee with a pad of pre-signed but otherwise blank prescription forms for the employee to fill out and issue to patients in what the two referred to as “drive-by” visits.
Patients would take those prescriptions and fill them at local pharmacies, causing Medicare to pay for them through the Part D prescription drug program. The government determined that more than 200 prescriptions for controlled substances were filled by more than a dozen Medicare patients in this manner in 2015, according to Murray.
Had Medicare known that the employee and not Khanna had completed and issued these prescriptions, it would not have paid for them, Murray said.
Khanna also provided a patient covered by private insurance with pre-signed but otherwise blank prescriptions for that patient to fill out for her own use, the U.S. attorney said. The patient completed the prescriptions, in some instances after exchanging text messages with the defendant and then presented them at local pharmacies as if they had been written and provided by Khanna.
The patient obtained Oxycontin, Adderall and Percocet, all controlled substances, with these fraudulent prescriptions, Murray said.
Khanna is scheduled to be sentenced Jan. 4. She has agreed to pay $127,264.98 in restitution to the Medicare program. As part of her plea agreement, Khanna, who already surrendered her Drug Enforcement Administration license during the investigation, has agreed to not seek a new DEA registration for 10 years.
She also faces a minimum five-year debarment from participating in the Medicare program.
“The battle against opioids is being waged on numerous fronts,” Murray said. “One sad reality is that there are health care providers who have contributed to the opioid crisis by engaging in illegal conduct. As this case demonstrates, the U.S. Attorney’s Office and our law enforcement partners are working together to identify and prosecute health care providers whose prescribing practices violate the law.”
“As New Hampshire battles the opioid epidemic we simply cannot allow unqualified individuals to recklessly oversee blank, pre-signed prescription pads,” said Phillip M. Coyne, special agent in charge of the Office of Inspector General for the U.S. Department of Health and Human Services. “This investigation succeeded through joint teamwork with the Drug Enforcement Administration. And we look forward to working with local, state and other federal law enforcement partners on future cases.”
The case is being prosecuted by Assistant U.S. Attorney Charles L. Rombeau.
Source: The Eagle Tribune