Philadelphia, PA – United States Attorney William M. McSwain recently announced that Andrew M. Berkowitz, M.D. of Huntington Valley, PA, was charged by Indictment with 19 counts of health care fraud, and 23 counts of distributing oxycodone outside the course of professional practice and without a legitimate medical purpose.
According to the Indictment, Berkowitz operated a medical practice in Philadelphia under the name ‘A+ Pain Management’, and through this practice Berkowitz fraudulently billed insurers for medically unnecessary physical therapy, acupuncture, chiropractic adjustments, and prescriptions drugs – and sometimes for treatments not provided at all.
Regardless of their individual complaint, at every visit A+ patients received a “goodie bag” which was a tote bag filled with prescription drugs for which Berkowitz submitted pharmacy claims through his company, Bucks Philadelphia Medical Care Group. The “goodie bags” typically included a combination of drugs such as Topical Analgesics, such as Relyyt and/or Lidocaine; Muscle Relaxers, such as Chloroxazon and/or Cyclobenzaprine; Anti-Inflammatories, such as Celecoxib and/or Nalfon; and Schedule IV controlled substances, such as Tramadol for pain; and/or Eszopiclone and Quazepam for insomnia and anxiety. Berkowitz obtained payments from insurers of more than $4,000 for each bag by falsely asserting that the drugs were for the benefit of the patient when, in reality, Berkowitz was the real beneficiary.
The Indictment also alleges that Berkowitz would prescribe Oxycodone to “pill-seeking” patients in exchange for their tacit approval that he would submit excessive claims to the patients’ insurers for the “goodie bag” and other medically unnecessary services. For 2015 through 2018, Berkowitz obtained an estimated $3.2 million in fraudulent proceeds from his “goodie bag” scheme.
In addition to the criminal charges, the Affirmative Civil Enforcement (ACE) Strike Force of the U.S. Attorney’s Office also filed a civil suit for an injunction to stop any future healthcare fraud and to freeze much of the defendant’s assets pending the criminal and civil investigations. The court granted the government’s request and entered a temporary restraining order against the defendants pending additional proceedings.
“The U.S. Attorney’s Office is committed to bringing all of our enforcement tools to bear against healthcare fraud and drug diversion,” said U.S. Attorney McSwain. “Today’s case is the latest example of our Criminal Division working in tandem with our ACE Strike Force to pursue fraud and diversion that allegedly put dangerous and addictive pills onto the street in the midst of the ongoing opioid epidemic.”
“Again and again, we’re seeing these doctors with dollar signs in their eyes, willing to abandon all pretense of professional ethics,” said Michael T. Harpster, Special Agent in Charge of the FBI’s Philadelphia Division. “As alleged, Berkowitz made millions by diverting dangerous drugs to anyone who wanted them, with Medicare — and ultimately, American taxpayers — picking up the tab. The FBI, with the Philadelphia Police and our federal partners are doggedly working to put medical professionals engaged in this kind of fraud out of business.”
If convicted, the defendant faces a maximum possible sentence of 660 years in prison.
The case was investigated by the Federal Bureau of Investigation; the Philadelphia Police Department, Health and Human Services – Office of Inspector General, Office of Personnel Management – Office of Inspector General, and Department of Labor – Office of Inspector General, and is being prosecuted by Assistant United States Attorney M. Beth Leahy. The civil action is being handled by Assistant United States Attorney Anthony Scicchitano.
An indictment, information, or criminal complaint is an accusation. A defendant is presumed innocent unless and until proven guilty.
Source: US DOJ