The office of Massachusetts Attorney General Martha Coakley has opened an investigation into what it described as an intricate Medicaid kickback scheme run by a Brookline doctor, specializing in addiction and alcohol testing and treatment from a string of 29 branch clinics across Massachusetts, including one in Vineyard Haven.
Massachusetts State Police assigned to the attorney general’s (AG) office arrested Dr. Punyamurtula Kishore, 61, at his Brookline house September 20. He was arraigned in Malden District Court the following day on one count of Medicaid kickbacks, according to a press statement.
Dr. Kishore pled not guilty and was ordered held on $150,000 cash bail. He was ordered to surrender his passport. Dr. Kishore is a citizen of India who has lived in this country since 1977 on a green card, according to the Cape Cod Times.
Investigators said Dr. Kishore paid the president of Fresh Start Recovery Coalition Inc., a Malden Company that owned and operated sober houses across the state, to send patients to his laboratories to perform “medically necessary” urine drug screening tests of Medicaid eligible residents.
The attorney general’s office said the scheme involved approximately $500,000 in taxpayer funds.
“Medicaid fraud cases involve the theft of taxpayer dollars and undermine the integrity of our health care system,” Ms. Coakley said. “In this case, we allege that Dr. Kishore orchestrated a complex kickback scheme to funnel drug screen business to his laboratories and then bill MassHealth for those services. Our investigation continues into his practices.”
Dr. Kishore owns and manages Preventive Medicine Associates Inc. (PMA). PMA is a network of 29 medical branches throughout Massachusetts, some of which include physician office laboratories, and one independent clinical laboratory, according to the AG’s office.
In the week before his arrest, Dr. Kishore, the target of a grand jury investigation, suddenly shut some of his offices, including several on the Cape. That prompted state officials to act in the event that he was preparing to flee the country.
A spokesman for the AG’s office said Friday there was no information linking the Vineyard to the indictments handed down last week, but that the investigation continues.
The lights were out on September 22, in the office of Vineyard Healthcare, at the Woodland Center off State Road in Vineyard Haven.
“We are terribly sorry for any inconvenience,” a sign on the door said. “Due to circumstances beyond our control this office will not be open until further notice.”
The sign recommended people call 911 for emergencies, go to the Martha’s Vineyard Hospital emergency room, or contact Dr. Kishore directly at his 24-hour hotline, 1-800-770-1904, an answering service.
Dr. Kishore did not return a message The Times left Friday inquiring about the future of his Vineyard Haven office.
Island employees closed shop
Dr. Kishore shut his Cape offices. On the Vineyard the employees beat him to it.
After going without a paycheck for many weeks the employees closed the door on September 16, acupuncturist Marcie Mueller told The Times in a telephone conversation Friday. In a conversation with a Times reporter, Ms. Mueller was surprised to learn that State Police had arrested Dr. Kishore days earlier for Medicaid fraud.
“We did everything we could to get in contact with Dr. Kishore and get paid, and there has been no pay coming, so our only recourse was to shut the office down,” she said. “It was not something anyone wanted to do. We could not work for nothing.”
Ms. Mueller said that although she worked at the clinic on a part-time basis and was not familiar with the details of the operation, she was not surprised that the network of clinics would unravel.
“Just the general mismanagement of that place the whole time I had been there was just incredible to me,” she said.
The Vineyard office opened in February 2007 and claimed to provide a full range of treatments for people with substance abuse problems, without the use of further addictive pharmaceuticals. The clinic also provided urine testing services for a variety of Island clients.
It filled an important niche, Ms. Mueller said. She used acupuncture in withdrawal treatment.
Initially, Vineyard Healthcare was considered a rehab clinic. Several Island organizations, including the hospital, Martha’s Vineyard Community Services and the courts referred people to the clinic, she said. But, over the years the patient base dropped off.
“I think that speaks to the mismanagement of the place,” Ms. Mueller said. “By the end we were seeing very few patients. A couple of years ago we were seeing many, many more for a lot of different reasons. It certainly does leave a big gap in health care on the Island.”
One organization that lost faith is Vineyard House, an Island nonprofit that houses Island men and women in need of a safe living environment while they are in the early stages of recovery from alcohol and drug addiction.
Board president Mark Jenkins said Vineyard House used Vineyard Healthcare only for the random drug testing it requires of all its residents.
“We terminated our relationship with them several months ago after a continued level of dissatisfaction on our part,” Mr. Jenkins said, “with respect to both their performance and also the behavior of their personnel, specifically with respect to non-observance of basic confidentiality and discretion.”
DPH issues alert
On September 23, the Massachusetts Department of Public Health issued a health alert, in response to the closing of PMA clinics across the Massachusetts.
The alert said that PMA clinics treated a significant number of patients for opiate addiction and some of them were receiving Vivitrol®, a once-per-month injection of Naltrexone, used along with counseling and social support to help people stop abusing alcohol and drugs.
Patients from the closed sites have been contacting the DPH Bureau of Substance Abuse Services (BSAS) and addiction treatment providers, seeking guidance on obtaining referrals to providers able to continue their Vivitrol® injections, according to the alert.
DPH said it is working with health care providers to identify PMA patients receiving Vivitrol®, to alert these patients about the PMA office closings, and to assist them in obtaining continued treatment.
“Of great concern to DPH is the increased possibility of lapse or relapse to opiates for those whose treatment is interrupted,” the alert said. “As many providers and opiate users are aware, persons who have a period of abstinence from opiate use and who subsequently use opiates again are at high risk for overdose.”
For more information call the Massachusetts Substance Abuse Information and Education Helpline at 1-800-327-5050 or go to www.helpline-online.com.