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One of the clinics was located on Sheridan Avenue in the Bronx.
By Forum Staff
Two physicians have been charged with conspiring to operate an opioid mill and fraudulently billing Medicaid, State Attorney General Tish James announced on Monday.
Ilya Smuglin, M.D., of Rego Park, and Rockville Centre resident Clarisse Clemons, M.D., were arraigned on Friday on a complaint charging them with criminal sale of a prescription for a controlled substance or of a controlled substance by a practitioner or pharmacist; first-degree healthcare fraud; and fourth-degree conspiracy. Both Smuglin, 50, and Clemons, 63, were ordered to surrender their passports and were released on their own recognizance. The case was adjourned to June 12.
According to James, the AG’s Medicaid Fraud Control Unit filed papers alleging that Smuglin, Clemons, and other staff of the Miromedical P.C. and Ferrara Medical Care, P.C. clinics, conspired to create, enable, and foster an environment that encouraged and resulted in the excessive prescribing and sale of prescriptions for Suboxone, a narcotic drug used to treat pain and opioid addiction. The prescribing and sale of prescriptions for Suboxone resulted in an influx of patients who were the means for the defendants and others to file and cause to be filed false Medicaid claims. These clinics, located in the Bronx and Manhattan, respectively,operated as unauthorized, uncertified providers of substance abuse treatment services.
State law mandates that substance abuse treatment programs be certified by the Office of Alcohol and Substance Abuse Treatment Services in order to treat those suffering from addiction. State and federal law further regulates how such treatment is to be conducted in order to heighten the chances of a successful recovery, James noted.
The attorney general’s office alleges that the physicians and their co-conspirators participated in a scheme to lure Medicaid patients to the clinics by paying kickbacks and offering prescriptions for Suboxone, which has the potential for abuse. Once recruited, prosecutors allege that patients encountered the façade of a substance abuse treatment program. Appropriate and necessary medical histories were not always obtained, physicals and urine toxicology were not regularly performed, and patients were consistently provided with prescriptions for Suboxone at the maximum dose, without any effort to taper or wean the patient off the narcotic in violation of applicable treatment guidelines. As part of this scheme, Smuglin and Clemons allegedly regularly gave pre-signed and otherwise blank prescription pads to medical and non-medical staff within the clinics, which enabled them to hand out prescriptions, including ones for controlled substances, to patients without medical need. Once the Suboxone prescriptions were obtained, prosecutors allege that patients were regularly offered money from drug dealers inside and outside of the clinic, often in plain view of physicians and employees.
Prosecutors further allege that relying on the accuracy of claims submitted for these Suboxone prescriptions, Medicaid and MetroPlus, a Medicaid managed care organization, paid pharmacies filling the prescriptions over $3 million in 2015 and over $2 million in 2016.
If convicted on the top charge, Smuglin and Clemons each face a maximum penalty of eight and a third to 25 years in prison.
“We will not tolerate attempts to fraudulently use the Medicaid program to take advantage of those suffering from addiction,” James added.
