Monday, March 30, 2009

Health Care: Two Miami Doctors and Others Convicted of Bilking Medicare

Two Miami physicians along with several other persons were convicted in federal court in Miami of conspiracy to defraud Medicare of millions by making fraudulent claims for treating HIV patients. Drs. David Rothman and Keith Russell and the others were convicted by a jury of engaging in a conspiracy to bilk Medicare.

Medicare paid clinics owned and operated by the defendants $2.5 million for HIV infusion treatments. The government proof was that the treatments were either medically unnecessary or never given to the patients. Testimony at trial established that owners of the clinics paid Rothman $200,000 and Russell $40,000 for writing the infusion prescriptions.

Infusion therapy is an outdated method of treating HIV that involves intravenous therapy. The current method of treating HIV is with antiretroviral drugs. These are typically administered orally and are commonly referenced as a antiretroviral "cocktail." This method of treatment has been very successful in turning HIV into a managed chronic disease.

The case is important because it is another example of the willingness of the government to bring a criminal action based on a theory of unnecessary medical treatment. Until relatively recently the government has shied away from cases alleging medically unnecessary treatment. However, the government has more recently shown a willingness to press the theory in a fraud context.

For a more in depth article on the conviction, please see The Miami Herald, "Doctors, Assistants Convicted of Medicare Fraud," March 18, 2009.

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