Dr. Jayam Krishna Iyer, 66, of Clearwater, Florida, who pleaded pleaded guilty to one count of healthcare fraud on Sept. 18, 2018, was sentenced by U.S. District Judge James S. Moody Jr. on Jan. 30 to six months in federal prison.
He also ordered Iyer to forfeit over $52,000 in health care fraud proceeds, and ordered her to pay restitution to the Medicare and Medicaid programs.
In addition, the court ordered Iyer to forfeit her Florida medical license, permanently excluding her from participating in the Medicare and Medicaid programs. Iyer also agreed to surrender her Drug Enforcement Administration registration number, which had been used to prescribe controlled substances, and not to reapply for a DEA registration number for at least 20 years.
Iyer could have faced a maximum penalty of 10 years in federal prison, or 20 years, if her offense had involved serious bodily injury, but thanks to a plea bargain she escaped with just six months in prison and the forfeiture of her ill-gotten gains and agreeing to reimburse Medicare and Medicaid for the fraud she had perpetrated.,
According to the plea agreement, Iyer owned and operated Creative Medical Center located on Druid Road East in Clearwater. The center functioned as a pain management clinic. Iyer billed Medicare and Medicaid for office visits, tests, and services provided to patients using her National Provider Identification (NPI) number, and wrote prescriptions for controlled substances, including oxycodone. She used Current Procedural Terminology (CPT) code 99213, which was used to bill for office visits for the evaluation and management of established patients, and required an in-person examination with the actual patient. As an approved Medicare provider, Iyer also agreed to provide truthful information and to not make any materially false statements or representations in connection with the delivery of or payment for health care benefits.
Beginning at least as early as July 2011, and continuing through December 2017, she executed and carried out a scheme to defraud Medicare by billing for face-to-face office visits with Medicare beneficiaries, when, in fact, certain patients did not go to her office and were not examined by her on the claimed dates.
Instead, family members of the patients went to Iyer’s office with notes requesting that Iyer issue and provide prescriptions, including for Schedule II controlled substances like oxycodone, to the family members, and in the beneficiaries’ names—and Iyer issued those prescriptions.
She thereby violated a Florida law requiring doctors to perform an in-person office visit and examination of each patient before issuing Schedule II controlled substance prescriptions. Iyer also falsified her electronic medical records, including vital statistics, to make it appear that the actual patient was present in her office for an office visit, when the patient was not. Iyer submitted at least $51,500 in these types of false and fraudulent Medicare claims.
This case was investigated by the Opioid Fraud and Abuse Detection Unit. On August 2, 2017, then Attorney General Jeff Session announced the formation of the Opioid Fraud and Abuse Detection Unit, a Department of Justice pilot program to utilize data to help combat the devastating opioid crisis that is ravaging families and communities across America. The unit focuses specifically on opioid-related health care fraud using data to identify and prosecute individuals that are contributing to the prescription opioid epidemic.