Pennsylvania Record

Thursday, August 15, 2019

U.S. alleges Huntington Valley doctor submitted more than $9 million in excessive claims, committed fraud

Federal Court

By Charmaine Little | Aug 9, 2019


PHILADELPHIA – The U.S. government alleges in a suit filed in the U.S. District Court in the Eastern District of Pennsylvania that a Huntington Valley doctor and his pain management clinic committed health care fraud.

It is alleged that defendants Dr. Andrew M. Berkowitz and his Bucks Philadelphia Medical Care Group LTD “have engaged in, and are continuing to engage in, criminal health care fraud through the submission of claims for medically unnecessary and improper drug dispensing in violation of 18 U.S.C. section 1347, and are alienating and disposing of funds obtained as a result of that fraud” according to the lawsuit.

The suit states Bucks Philadelphia Medical Care Group does business under the name of A+ Pain Management.

The government is asking the court to bar the defendants from participating in any further health care fraud and to block them from using money they allegedly earned in the scheme.

Berkowitz enrolled as a Medicare provider in January 2007, then registered as a non-pharmacy dispensing site (PDS) around August 2014, the suit says. That license allowed him to dispense prescription drugs from his practice, the suit states.

But the U.S. alleges between Jan. 1, 2015, and Dec. 31, 2018, the defendants “submitted excessive claims to Medicare, IBC and Aetna, among others, for pharmacy dispensing totaling $9.08 million..."

Berkowitz is alleged to have made more than $3.8 million in paid claims. The suit states he came under fire after Independence Blue Cross investigators told the Federal Bureau of Investigation about several complaints it received concerning Berkowitz.

The suit states the FBI sent in a cooperating witness in April 2017, who told Berkowitz they didn’t have insurance. Berkowitz allegedly shut down the option of Medicaid and said “the Medicaid thing doesn’t work for us,” the suit states. Berkowitz allegedly gave the witness a prescription for 70 pills of Oxycodone, 90 pills of Motrin and 60 pills of Flexeril. The undercover patient allegedly paid $185. 

The government seeks injunctive relief that would enjoin the defendants from engaging in the Medicare program or any private insurer and for restitution. It is represented by U.S. attorneys in the U.S. Attorney's Office in Pittsburgh.

U.S. District Court in the Eastern District of Pennsylvania case number 2:19-cv-02719

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