Summary
This case involves a physician who voluntarily surrendered their New York medical license following disciplinary action taken by Illinois authorities. The physician had been indefinitely suspended in Illinois in October 2012 for fraudulent Medicaid billing practices, including submitting claims for Tramadol prescriptions without a legitimate medical purpose and for office visits that were not medically necessary or adequately supported by documentation. The physician also entered into a settlement agreement with federal authorities, agreeing to permanent exclusion from Medicare/Medicaid programs and payment of a $50,000 fine. Rather than contest reciprocal disciplinary charges in New York, the physician chose to surrender their license.
Effective Date: September 18, 2013
Type of Doctor: M.D. (Medical Doctor) – Licensed October 1, 1982
Disposition Type: Voluntary Surrender of License
How many total charges? 1 specification of professional misconduct
What specifications of charges were alleged? Professional misconduct under N.Y. Education Law § 6530(9)(d) – having a license to practice medicine revoked and/or having other disciplinary action taken or having surrendered a license to practice medicine after a disciplinary action was instituted by a duly authorized professional disciplinary agency of another state, where the conduct resulting in the surrender of license, revocation of license and/or other disciplinary action would, if committed in New York state, constitute professional misconduct under New York laws.
The underlying Illinois action was based on allegations that the physician submitted or caused to be submitted fraudulent claims to Medicaid by:
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- Issuing prescriptions for Tramadol to patients without legitimate medical purpose
- Billing for office visits with patients for services that were not medically necessary and/or not adequately supported by medical record documentation
How many patients were involved in each charge? Multiple patients (exact number not specified). The fraudulent billing involved prescriptions for Tramadol and unnecessary office visits affecting multiple patients over an unspecified time period.
Which charges was the licensee guilty of (either via hearing or negotiated consent)? The physician did not contest the charge and explicitly stated: “I do not contest the one (1) Specification” in the surrender agreement. By accepting the surrender terms, the physician effectively accepted responsibility for the reciprocal discipline based on the Illinois action. Additionally, the physician had already entered into a settlement agreement with federal authorities regarding the underlying conduct.
Which charges was the licensee not guilty of? Not applicable – there was only one charge, and the physician chose not to contest it through the surrender agreement.
Outcome/Penalties (specific to this case):
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- Voluntary surrender of medical license in New York State
- Physician’s name stricken from the roster of physicians in New York State
- Immediate cessation of medical practice in New York State
- Required to deliver the original license and registration to OPMC within 5 days
- Required to notify all patients within 15 days of cessation of practice and refer them to other licensed practitioners
- Required to arrange for the transfer and maintenance of all patient medical records within 30 days
- Must surrender any DEA-controlled substance privileges within 15 days
- Must return unused prescription forms to the Bureau of Narcotic Enforcement within 15 days
- Must remove all public representations of eligibility to practice medicine within 15 days
- Prohibited from charging, receiving, or sharing fees for professional services while barred from practice
Background Context: The underlying misconduct occurred in Illinois, where on October 19, 2012, the Illinois Department of Financial and Professional Regulation indefinitely suspended the physician’s license by consent order. On June 19, 2012, the Illinois Board learned the physician had entered into a settlement agreement with the U.S. Department of Justice on behalf of the Office of Inspector General of HHS and the Illinois Attorney General. Under this settlement, the physician agreed to permanent exclusion from Medicare, Medicaid, and all other Federal Health care programs and to pay a $50,000 fine. The conduct would have constituted multiple violations under New York law, including gross negligence, negligence on more than one occasion, practicing fraudulently, and failure to maintain adequate records.