Clinically Fraudulent

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Close-up Of A Doctor's Hand Analyzing Report On White Desk

A doctor is supposed to advocate for their patients and uphold the Hippocratic Oath. While most doctors do this, there are a few rotten apples who seek to take advantage of their patients. This is the case for a doctor from Port Neches, Tex., who has been convicted for their role in a $6.7 million healthcare fraud scheme.

Grigoriy Rodonaia was convicted on 12 counts of healthcare fraud, three counts of aggravated identity theft, making a false statement and two counts of accepting kickbacks. (His mother must be so proud.)  

Rodonaia was a practicing physician with Rodonaia Family Medicine and Aesthetics in Beaumont. Dr. Rodonaia launched his healthcare fraud scheme in January 2015. He abused his position as a trusted physician by prescribing specialty compounded scar creams that were not medically necessary for patients who had no knowledge of these prescriptions.

As part of the scheme, Rodonaia used the names, dates of birth, and Health Insurance Claim Numbers of Tricare beneficiaries to issue prescriptions for expensive compound creams. (Tricare provides civilian health benefits for U.S. Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve.) He directed the prescriptions to be forwarded to Memorial Compounding Pharmacy in Houston, Texas. (The name is certainly fitting, because this scam is certainly memorable, but in a bad way.)

Compound creams must be specially mixed by pharmacists. They are generally only prescribed if a patient is allergic or nonresponsive to an ingredient in the generic version of a cream. (Their special classification makes the compound creams extremely expensive.)

The creams that Rodonaina prescribed were billed to Tricare for between $9,000 and $13,000 each, with the authorization of multiple refills per prescription. (That insured a steady stream of illegal income.) Rodanaia used the names of approximately 140 Tricare beneficiaries to issue more than 600 compound cream prescriptions.

In total, TRICARE paid $6.7 million dollars in reimbursements to Memorial Compounding Pharmacy throughout the duration of this fraudulent billing scheme. (Those creams better cure cancer for that extreme price.)

Rodonaia attempted to conceal his billing fraud scheme by creating fictitious patient files that asserted he had consulted with patients before prescribing the compound creams. (The only thing he consulted with was his pocketbook.) He submitted these falsified records as part of an audit conducted by the Defense Health Agency.   

Additionally, Rodonaia violated the federal Anti-Kickback Statute. He illegally required Medicare and Medicaid beneficiaries, who were seeking opioid treatment, to pay cash for office visits in excess of the amount which would have been reimbursed by Medicare and Medicaid. (What a nice guy. He was not only dedicated to stealing their money, but also getting them hooked on opioids.)

Rodonaia faces up to 10 years in prison for each count of healthcare fraud and an additional two year consecutive term of imprisonment for each count of aggravated identity theft. (He will most likely owe Tricare a pretty penny in restitution as well.) He remains released on conditions and under the supervision of the U.S. Pretrial Services office until sentencing.

Today’s Fraud of the Day comes from an article, “Beaumont doctor found guilty in $6.7 million health care fraud scheme,” published by 12News on November 17, 2020.

BEAUMONT, Texas — A Beaumont doctor has been convicted in connection with a $6.7 million federal health care fraud scheme.

Grigoriy T. Rodonaia of Port Neches, was convicted by a jury on Tuesday for 12 counts of health care fraud, three counts of aggravated identity theft, making a false statement and two counts of accepting kickbacks according to a Department of Justice news release.

 

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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.