Insurance Fraud NEWS
Fake doc allegedly injects patients with dirty needles in Michigan
March 13, 2019, Oak Park, MI
An unlicensed man is accused of handling injections for his 84-year-old father and using non-sterile needles at a pain clinic in Oak Park, according to FBI agents.
Patients said Sanjit James Jayakar admitted he handled injections for his father, Gandam Samuel Jayakar, who was licensed, because his father's hands are too shaky.
The pair is also accused of billing Medicare $2.77 million for services that weren't necessary or weren't performed by a licensed doctor between April 2017 and February 2019. On Tuesday, FBI agents raided the Pain Stop facility at 25900 Greenfield Road.
Specifically, the Jayakars are accused of submitting false claims for spinal facet joint injections and neurostimulator pulse generators, according to court records.
Pain Stop accused of false claims
In February, AdvanceMed accused Pain Stop of falsely billing Medicare for implantable stimulator device pulse generators after witnesses said the clinic was instead using electroacupuncture devices that only attach to the surface of the skin.
Electroacupuncture devices aren't covered, but the Jayakars were billing Medicare as if they were providing implantable devices, according to AdvanceMed.
According to a review of Medicare claims, Pain Stop billed Medicare for about $2,777,575 between April 17, 2017, and Feb. 19, 2019. The clinic was reimbursed $694,415.52, officials said.
Unlicensed son doing injections
This month, FBI agents received an unrelated complaint that Sanjit Jayakar was doing non-sterile facet joint injections for his father.
His father has been licensed in the state of Michigan since January 1976, and is the managing employee, authorized official and part-owner of Pain Stop, according to authorities.
Medical enrollment documents for the clinic list Sanjit Jayakar as the practice administrator as of around January.
Patients interviewed by FBI
Patients say devices weren't surgically implanted
On Dec. 18, investigators spoke with two people who got treatment at Pain Stop, according to court records.
One man told officials he had twice received a neurostimulator device on his ear without having it surgically implanted.
A woman told officials she had received three neurostimulators -- none of which she wanted -- that were not surgically implanted.
A program integrity analyst with AdvanceMed told investigators the clinic could be using DyAnsys devices that aren't reimbursed by Medicare because the devices are considered acupuncture.
Woman says 'assistant' performed injections
On March 7, a woman told investigators she had received an electrostimulator device on two different trips to Pain Stop. She said they went behind her ear and each time she took it off and threw it away after five to seven days, according to officials.
Investigators said the clinic had billed the woman's Medicare insurance for two implantable neurostimulator pulse generators on July 25 and Aug. 2. The claims were for a total of $5,644.80, officials said.
She told officials that when she was receiving back injections at Pain Stop, an older doctor was in the room, but an assistant would perform the injections. Investigators said she identified a photograph of Sanjit Jayakar as the assistant who did the injections.
She said Sanjit Jayakar would identify himself as an assistant to the older doctor, who she identified as Gandam Jayakar in a photo, FBI agents said.
Investigators said Medicare was billed for a series of three joint facet injections given to the woman on Sept. 26, Oct. 4, Oct. 12 and Nov. 9, all in 2018. Gandam Jayakar was listed as the provider, and Medicare reimbursed Pain Stop $1,072.29, according to authorities.
Sanjit Jayakar takes over patient's injections
Another patient told investigators on March 7 that she had received at least one pain injection from Sanjit Jayakar while being treated at Pain Stop, officials said.
According to court documents, the woman said Gandam Jayakar was present during the injection, but he was just sitting in the room during the procedure.
She told authorities that a woman provided the first two injections she received, but Sanjit Jayakar took over because she the woman no longer worked at the clinic, according to court records.
Medicare records show Pain Stop made four claims for series of three facet joint injections last year: Oct. 11, Oct. 23, Nov. 13 and Dec. 3, officials said. A total of $1,429,72 was reimbursed, according to records.
Former employee opens up
On March 8, FBI agents spoke with a former Pain Stop employee who came forward voluntarily for the first time. The former employee has been a licensed nurse for about 16 years and is a registered nurse practitioner, officials said.
The employee said Sanjit Jayakar admitted to another worker that he was not a doctor, but that he helps his father insert the needle for facet joint injections because Gandam Jayakar's hands are too shaky, according to court records.
According to the former employee, patients and other workers would call Sanjit Jayakar "doctor," and he wouldn't correct them. He would meet with patients and tell them how to treat their pain, according to the former employee.
There was a nurse practitioner who would go to Pain Stop to do joint facet injections on Tuesdays and Thursdays, and Sanjit Jayakar would critique their technique and performance, the former employee said.
Investigators reviewed the Medicare claims for facet injections on Mondays, Wednesday and Fridays in November 2018 and found 24 separate injections given to eight patients, billing Medicare for about $34,400.
On one occasion, the former employee said Sanjit Jayakar told a patient that someone else would be taking over their injections and the patient said, "Oh, doctor, I'm so used to you. I don't feel comfortable with anyone besides you."
Sanjit Jayakar accused of non-sterile practices
The former employee told FBI agents that in or around December 2018, Sanjit Jayakar gave a patient a facet joint injection without using sterile protocol.
Officials said Sanjit Jayakar wore non-sterile medical gloves with a tear on one hand.
The former employee said Sanjit Jayakar wiped his nose and then proceeded to pick up the needle and insert it into the patient with the same hand.
Gandam Jayakar was in the room but was not physically helping with the procedure, according to the former employee.
Experts weigh in
A board certified orthopedic physician with Beaumont Hospital told officials that an unlicensed person shouldn't administer these injections under any circumstances.
He said the risks of improperly inserting the needle could be catastrophic, including nerve damage, infection, paralysis, loss of a limb or death, according to records.
A physician with Wisconsin Physicians Services, which is responsible for the administration of Medicare in Michigan, said a person without formal advanced medical training is not qualified to perform facet injections.
He said the a person needs advanced training in back pain management and dealing with the potential immediate complications and follow-up care, officials said.
An official with AdvanceMed told agents that any claims submitted by Gandam Jayakar that had been administered by his son would be denied because the injections were performed by an untrained person.
A criminal complaint accuses the Jayakars of committing health care fraud and conspiracy to commit health care fraud.
Health care fraud and conspiracy to commit health care fraud have maximum penalties of 10 years in prison and fines.
Source: Click On Detroit