An Addiction to Fraud

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Stethoscope on 100 dollar bills symbolizing financial surveillance

A pain management doctor from Buffalo, N.Y., has been added to the growing list of medical professionals who have contributed to the nation’s opioid crisis. Dr. Gautam Arora pleaded guilty to prescribing controlled substances with the purpose of defrauding a federal healthcare program.

Between April 2013 and May 2017, Arora worked at Hens Pain Center in Amherst as a pain management doctor. During this time, he issued prescriptions to patients without a legitimate medical reason. (This goes against the Hippocratic Oath for sure.)

Most of the prescriptions were for controlled opioids including hydrocodone, oxycodone, dextroamphetamine-amphetamine and carisoprodol. (Of all people, a pain management doctor should be aware of the pros and cons of prescribing opioids. He really didn’t care about his patients or the potential for them to become addicted.)

The prescriptions were for individuals who were either not his patients or had not received an examination to verify their medical condition. He also neglected to assess each patient’s risk of abuse. (I would think these are basic steps a doctor learns on day one of medical school.)

Arora is also facing charges for attempting to defraud Medicare. Between January 1 and March 31, 2016, Aurora fraudulently billed Medicare for patient office visits totaling $92,209.50. He received reimbursement for medical services he did not perform or did not perform to the extent represented. (I’d argue that Arora’s specialty is not pain management, but actually pain infliction.)

When sentenced, Arora could face a maximum of 10 years and be required to pay a fine of $250,000.

If you suspect a healthcare professional of Medicaid or Medicare fraud, please report it by phone at 1-800-447-8477 or via email to HHSTips@oig.hhs.gov. 

Today’s Fraud of the Day comes from an article, “Former Amherst pain doctor pleads guilty, faces maximum of 10 years in prison on fraud charges,” published by WVIB on January 27, 2021.

BUFFALO, N.Y. (WIVB)– Dr. Gautam Arora, 44, formerly of Buffalo pleaded guilty to fraud involving controlled prescriptions and working to defraud a health care benefit program, according to the Office of the United States Attorney Western District of New York.

The U.S. attorney’s office tells us, Arora pleaded guilty to unlawfully acquiring controlled prescriptions by misrepresentation and fraud and scheming to defraud a health care benefit program.

 

 

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.