Docs on trial for operating alleged prescription drug ring
A federal prosecutor on Friday compared the operation of an alleged $54-million Warren-based prescription drug ring operated by doctors to a Mcdonald’s drive-thru and an assembly line.
Assistant U.S. Attorney Brandy Mcmillion presented the scenarios during her closing arguments in the joint trial of Rajendra Bothra of Bloomfield Hills, Ganiu Edu of Southfield, David Lewis of Detroit and Christopher Russo of Birmingham in U.S. District Court in Detroit.
“They (patients) were pushed through like an assembly line without regard to their health, welfare or well-being,” Mcmillion told a jury. “It was never about the patients. It was about the money.”
Her final remarks and those by the defense attorneys followed a six-week trial in front of Judge Stephen Markman.
The case will go to the jury Monday following the conclusion of closing arguments Friday afternoon.
The defendants are accused of conspiracy to distribute controlled substances and conspiracy to commit health care fraud over six years from 2013 through 2018 while operating The Pain Center USA and Interventional Pain Center in multiple buildings in Warren and Eastpointe. Each of the defendants face additional individual counts of health care fraud and/or drug distribution, Bothra, a native of India, was the owner of the clinics and the alleged ringleader. He is the only defendant who has been in custody despite his many legal attempts to be freed. On Friday, he was handcuffed and accompanied by a federal marshal when he left the courtroom for a recess.
The group was initially charged in December 2018, when federal officials raided the facilities and accused six physicians of operating a $464-million drug and health-care-fraud ring. Two of the six doctors charged — Eric Backos of Bloomfield Hills and Ronald Kufner of Ada — each pleaded guilty to one charge and testified at the trial.
Mcmillion said the defendants illicitly prescribed over 13 million pills, 9.9 million of which were Norco. The defendants made false claims to illegally collect over $20 million from Medicare, over $17 million from Medicaid and over $15 million from Blue Cross Blue Shield of Michigan, she said.
“The way the doctors operated at The Pain Clinic was not the way reasonable doctors operate,” she said. “The defendants were not acting in good faith.”
Patients typically went to the clinic upon a referral from another doctor to curb chronic pain, mostly back pain, Mcmillion said.
The defendants required patients to undergo a radio frequency ablations, which is performed via injection, to reduce pain in order to receive the opioids prescription, typically Norco, Mcmillion alleged.
“The evidence clearly shows it was quid pro quo,” she said.
The injections are supposed to be given every six to 12 months but often were dosed out monthly, according to Mcmillon. There were no informed consent procedures, she asserted.
“The more injections you did the more money you made,” she said of the defendants. “They didn’t discuss the risks or benefits of an injection” with the patients. “The assembly line was moving.”
Another scheme by Bothra was to force patients to accept a back brace, which cost $800 to $900, without an evaluation or discussion, according to Mcmillion. She accused Bothra of failing to custom fit the braces, referring to them as “off the shelf.” Patients often indicated the braces were uncomfortable and did not help relieve pain, she said.
Some of the fraud allegations involve doctors allegedly billing for physical therapy without actually performing it, she said.
Among those who testified were several actual patients and three undercover patients, two of them FBI agents and a paid informant.
Bothra’s attorney, Arthur Weiss, said U.S. Attorneys “glossed over the facts” and “cherry picked” 23 patients to produce the charges.
He noted that number of patients represents a miniscule percentage of the 24,700 patient visits over the six years.
He pointed out patients were not forced to go to the Pain Center, and often made repeat visits.
“These patients were always free to leave,” he said. “They weren’t locked in closets. They came back for more. They were getting care.”
Disputing the “assembly line” accusation, he said the four or five doctors saw 70 to 90 patients per day, and among them were 40 to 50 people per day who received the injections from two or three doctors.
“There was more than enough time,” he said. “This is not a factory. This was not a drive-thru. There was some benefit” to the treatments. “They were essential. They were reasonable.”
Weiss also discussed the background narrative of the opioid epidemic in the United States, beginning in the 1990s with the heavy reliance on opioids to treat pain before health officials realized the addictive nature of the drug.
He said Bothra was trying to follow Centers for Disease Control guidelines and other guidelines for opioid prescriptions.
Weiss denied Bothra misused the back braces, that all of the patients who received the device “had a back problem.”
Both sides used a few photographs and short videos to back their case.
Weiss showed a photo of Bothra, who was a world traveler, with Mother Theresa and the Pope. Edu’s attorney, Robert Harrison, showed a photograph of Edu and Kufner together at an office birthday party for Bothra, who is seen in photographs blowing out candles on a cake.
Harrison accused federal authorities of “targeting” The Pain Clinic to make a “big splash” to try to send a message to other doctors: “They’re coming after you.”
He attacked the quality of the investigation, criticizing the use of all the undercover patients, particularly the paid informant who was a crack-cocaine addict and was paid $16,800 in cash by the feds. He also accused the paid informant of being “high” when he testified.
“The government brought him into the courtroom and asked you to believe anything he says. It’s outrageous,” he told jurors.
He conceded Edu earned $5.3 million over the six years but did not manage his money well. Edu bought a modest $130,000 home in Southfield, he said.
“He gave money to charity, to his place of worship, to his family in Nigeria,” Harrison said. “Yes, it’s a lot of money. But doctors make a lot of money. Don’t be blown by the amount of money, no matter what the government tells you.”
Harrison also disputed specific details of the counts faced by his client, pointing to paperwork and recording mistakes. He tried to defuse the conspiracy charges, noting the rarity of prosecutors in conspiracy cases to fail to present evidence of meetings or telephone calls between the defendants.
“They charged without any evidence of anybody saying they’d do anything,” he said.
Both defense attorneys criticized the government’s use of audio recordings by a doctor who worked at the clinic for one day then quit, according to Mcmillion, because he believed the clinic’s doctors were operating unethically or worse.
The attorneys also challenged the government’s comparison of the Pain Clinic’s Warren building on Van Dyke north of Interstate 96 to a “train station,” with people waiting in long lines and a parking lot full of cars.
Harrison presented a video inside of the facility that didn’t show crowded areas but “immaculate” offices. Another photo showed a parking lot with one vehicle.
Harrison, who was seated, ended his closing arguments by placing a copy of the indictment in a garbage container next to his table and telling jurors: “This case has not been proven. I’m going to put this indictment where it belongs and ask you to find Dr. Edu not guilty.”
The trial also included expert witnesses on both sides.
In addition to the two conspiracy charges, Bothra faces 11 counts of health care fraud and three counts of drug distribution. Edu is also charged with 11 counts of health care fraud and two counts of drug distribution. Lewis is also charged with two counts of health care fraud and one count of drug distribution. Russo is charged with six counts of health care fraud.
Backos pleaded guilty in March to conspiracy to distribute controlled substances, punishable by up to 20 years in prison, court documents say. The deal includes him forfeiting $500,000, and the feds agreeing to a sentencing cap of 57 months in prison.
As part of his plea deal, Kufner pleaded guilty last October to health care fraud, punishable by up to 10 years in prison, and agreed to pay nearly $1.7 million, which is the amount he made in his 3-½ years working at the clinic, in restitution, according to court records. Kufner submitted $14.6 million in claims to Medicare and was approved for $2.1 million.