INDIANAPOLIS —
A medical doctor affiliated with The Pain Management Center of Southern Indiana, which has an office in Terre Haute, has been indicted by a federal grand jury for health care fraud and unlawful drug distribution.
Kamal Tiwari, 58, of Bloomington, was indicted last week, and the charges were unsealed following his arrest and appearance in federal court in Indianapolis. The charges are the result of a more than two-year investigation by the inspector general of the U.S. Department of Health and Human Services, Indiana Medicaid Fraud Control Unit, Office of the Attorney General and the FBI.
The indictment alleges that Tiwari defrauded health care benefit programs including Medicare, Indiana Medicaid and Anthem Blue Cross Blue Shield, and that from 2002 through 2007, he was paid more than $21 million by those three programs alone.
Tiwari does business as The Pain Management Center of Southern Indiana P.C., The Pain Management & Surgery Center of Southern Indiana Inc., and Southern Indiana Anesthesiology P.C., formerly known as Kamal Tiwari Inc. P.C.
A phone call to his Terre Haute office on South Fourth Street was referred to Tiwari’s Indianapolis attorney. The attorney did not return a call requesting comment on Tuesday.
The indictment alleges that Tiwari required patients to undergo medically unnecessary injection procedures, such as facet blocks, trigger point injections, radio frequency ablations and epidurals, as a condition of receiving narcotic controlled-substance prescriptions, such as methadone, Percocet, Oxycontin and oxycodone, all narcotic controlled substances.
The indictment alleges that the injection procedures were performed in a frequency and pattern that were not medically necessary, and were outside the bounds of medical practice and not for a legitimate medical purpose. The indictment also alleges that Tiwari prescribed controlled substances as part of a scheme to defraud, and that he did so in such dosage frequencies, combinations of controlled substances and in such amounts to drug-dependent patients that they were likely to cause and did cause those patients to submit to unwanted and unnecessary injection procedures and other service. The indictment also alleges that his actions caused those patients to become dependent on the medically unnecessary procedures.
The indictment sets out 16 patients who specifically received unnecessary procedures and improper drug prescriptions, according to the release from the Department of Justice. The indictment also alleges 11 counts of illegal drug distribution for prescriptions that were not for a legitimate medical purpose and beyond the bounds of medical practice.
If convicted, Tiwari faces a maximum 10-year prison sentence, a fine of $250,000 and supervised release of three years on the health care fraud count, a maximum sentence of 20 years in prison, a fine of $250,000 and supervised release of five years on the count of health care fraud resulting in serious bodily injury, and a maximum of 20 years imprisonment, a fine of $1 million and supervised release of up to five years on each of the 13 drug distribution counts.
Tiwari was released with pre-trial orders, including surrender of his passport, following the initial hearing in Indianapolis.
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