Indian American physician in New Mexico pleads guilty to health care fraud

Pawankumar Jain’s license was earlier revoked.

AB Wire

Pawankumar Jain, 63, an Indian American physician whose license was earlier revoked, entered a guilty plea on Thursday in federal court in Las Cruces, New Mexico, to unlawfully dispensing controlled substances and health care fraud.

Jain initially was charged in a 111-count indictment filed in April 2014.  The indictment charged Jain with 61 counts of unlawfully dispensing controlled substances and 50 counts of healthcare fraud.  A 138-count second superseding indictment filed in June 2015 added new charges for a total of 79 unlawful dispensing charges and 59 healthcare fraud charges, according to the Justice Department.

The superseding indictment alleged that Jain committed the offenses charged between April 2009 and June 2010, in Doña Ana County, N.M.  During that time, Jain was a licensed physician with a neurology subspecialty who operated a pain management medical practice in Las Cruces.  Jain’s medical license was suspended in June 2012, and subsequently revoked in Dec. 2012 by the New Mexico Medical Board.

The 79 dispensing counts in the superseding indictment charged Jain with unlawfully dispensing prescription painkillers, primarily Oxycodone and methadone, to patients outside the usual course of medical practice and without a legitimate medical purpose.  The 59 healthcare fraud counts alleged that Jain engaged in a scheme to defraud two federal health care benefit programs, Medicare and Medicaid, by submitting claims for payment for prescription medications he dispensed to patients outside the usual course of medical practice and without legitimate medical purpose.  The superseding indictment included allegations that Jain’s criminal conduct resulted in the deaths of four patients.

On Thursday, Jain pled guilty to one count of unlawfully dispensing a controlled substance and one count of health care fraud.

In his plea agreement, Jain acknowledged that from June 2007 through Feb. 2012, he was a licensed physician who practiced medicine in Las Cruces, and operated a “high volume practice, which included ‘pain management’ treatment for many patients.”

In his treatment of one patient identified as “M.E.B.,” Jain admitted conducting “cursory exams and [that he] did not document a therapeutic benefit from the narcotics he was prescribing for her.”  Jain’s plea agreement states that he last saw M.E.B. as a patient on Nov. 25, 2009 when he “conducted a superficial exam … [and] wrote two prescriptions, each for 270 tablets of methadone 10 mg, one dated November 25, 2009, and the second dated December 23, 2009.  M.E.B. filled each of these prescriptions, which were issued outside the usual course of medical practice and without a legitimate medical purpose. . . .  Two days after she filled the second prescription, M.E.B. died on December 25, 2009.”

Jain also admitted committing health care fraud in connection with his treatment of M.E.B.  Jain’s plea agreement states that he knew M.E.B. was insured by Medicare and that claims to cover the costs of the medication he prescribed for her would be submitted to Medicare for payment, which was in keeping with his scheme to defraud Medicare.  It further states that each of the two prescriptions Jain wrote for M.E.B. on Nov. 25, 2009, were submitted to Medicare for payment, which was consistent with his intent.

Jain has been in federal custody since April 2014, and remains detained pending his sentencing hearing, which has yet to be scheduled.  Under the terms of his plea agreement, Jain will be sentenced to a prison term within the range of 42 to 108 months followed by a term of supervised release to be determined by the court.