A federal jury found four Detroit-area physicians guilty today of health care fraud charges for their roles in a scheme to administer unnecessary back injections to patients in exchange for prescriptions of over 6.6 million doses of medically unnecessary opioids. Patients were required to get the injections in order to get the prescriptions, some of which were resold on the street by drug dealers, the evidence at trial showed.

After a four-week trial, Spilios Pappas, 62, of Lucas County, Ohio, Joseph Betro, 59, of Oakland County, Michigan, Tariq Omar, 62, of Oakland County, Michigan, and Mohammed Zahoor, 53, of Oakland County, Michigan, were each found guilty of one count of conspiracy to commit health care fraud and wire fraud, and one count of health care fraud. Sentencing has been scheduled for July 16 for Pappas, July 17 for Betro, July 24 for Zahoor and July 30 for Omar before Chief U.S. District Judge Denise Page Hood of the Eastern District of Michigan, who presided over the trial. Seventeen other defendants, including eight other doctors, previously pled guilty in connection with the investigation.

“These physicians subjected patients to medically unnecessary injections to reap millions in fraudulent billings. Worse still, they incentivized those treatments by offering opioid prescriptions in sky-high dosages meant for the terminally ill,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “Today’s verdict shows that the Department will root out physicians who let dollar signs rather than medical need drive their treatment of patients.”

“These doctors sought to enrich themselves by performing unnecessary back injections in exchange for highly addictive opioids, violating their Hippocratic Oath to do no harm,” said U.S. Attorney Matthew Schneider of the Eastern District of Michigan. “Our office will continue to prioritize the prosecution of doctors whose criminal behavior puts patients at risk.”

“Physicians take an oath that obligates them to do no harm to their patients. These four men willingly broke that oath – by providing unnecessary drugs and conducting unnecessary procedures – solely to line their pockets,” said Special Agent in Charge Steven M. D’Antuono of the FBI’s Detroit Field Office. “This guilty verdict sends a message to any doctor or healthcare professional who prioritizes profit or does harm to their patients under the guise of providing health care will be subject to the full investigative resources of the FBI and our law enforcement partners.”

“The public trusts that physicians will put patients’ health and safety first. These defendants violated that trust in pursuit of their own financial gain,” said Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services, Office of Inspector General Chicago Region. “The OIG takes matters of this nature very seriously and will continue to work with our law enforcement and prosecutorial partners to hold individuals who commit these kinds of criminal acts accountable.”

According to evidence presented at trial, from 2008 to 2016, Pappas, Betro, Omar and Zahoor worked at numerous medical clinics in Michigan and Ohio, which were operated under the name of the Tri-County Group (Tri-County) and owned by co-conspirator Mashiyat Rashid. While the defendants worked at Tri-County, they engaged in a scheme to defraud Medicare of over $150 million by billing for medically unnecessary facet joint injections, unnecessary urinary drug screens, home health and a myriad of other unneeded ancillary services. The evidence showed that patients, some of whom were suffering from legitimate pain and others of whom were drug dealers or opioid addicts, were offered prescriptions of oxycodone 30 mg by the defendants, but were forced to submit to unnecessary facet injections in exchange for the prescriptions.

Testimony at trial established that the patients experienced more pain from the shots, in some case, than from the pain they had purportedly come to have treated, and that some patients developed adverse conditions, including open holes in their back. Patients, including patients who were addicted to opioids, who told the doctors that they did not want, need or benefit from the injections, were denied medication by the defendants and their co-conspirators until they agreed to submit to the expensive and unnecessary injections.

The evidence further established that the defendants repeatedly performed these unnecessary injections on patients, as Tri-County was paid more for facet joint injections than any other medical clinic in the United States. The four defendants were all ranked in the top 25 doctors for dollars paid by Medicare for facet joint injections, even though they only worked a few hours a week. The defendants practice was described during trial as an assembly line, where the four defendants earned anywhere from $1,100 to $3,500 an hour for performing the same injections on nearly every patient.

In addition to the unnecessary injections, the defendants signed a standing order for urine tests for each patient and for every visit to be sent to National Laboratories, also owned by Rashid, in exchange for tens of thousands of dollars in illegal kickbacks, the evidence showed. The evidence further established that the physicians performed a quantitative test for 56 different drugs for every patient at every visit, regardless of whether the patients presented any reason for the test.

The evidence further established that the physicians provided prescriptions for narcotics, including opioids and benzodiazepines, as an incentive to patients who received the injections. Moreover, the evidence established that the dosage of opioids being provided to patients was suitable only for terminally ill cancer patients. Evidence from Michigan Automated Prescription System showed that the four defendants were among some of the top prescribers of oxycodone 30mg in the state of Michigan.

In 2015, Pappas was the number seven prescriber of oxycodone 30mg in the state of Michigan; Betro 18; Omar 16; and Zahoor 38 the evidence showed. At trial, oxycodone 30mg was described as the “gold standard” of drugs diverted to illegal purposes on the street. Evidence showed that all four defendants were in the top 40 out of 50,000 Michigan prescribers even though they had conspired with Rashid to “stay under the radar” of the U.S. Drug Enforcement Administration by working only a few hours a week. The doctors would see anywhere from 15-25 patients in a two to four hour shift, and then bill Medicare for office visits and procedure codes suggesting that they spent as much as two hours and 22 minutes with each patient. Every piece of the fraud was consistently implemented and applied to over 94 percent of the patients in the clinic.

The FBI and HHS-OIG investigated this case. Assistant Chief Jacob Foster and Trial Attorneys Tom Tynan and Anthony Burba of the Criminal Division’s Fraud Section are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.