A former Huntsville, Ala., physician who was the highest Medicare prescriber of opioid painkillers at the height of his practice in 2012, has pleaded guilty to criminal charges of illegally prescribing controlled substances and for health care fraud involving $9.5 million in unneeded and unused urine tests, which he billed to Medicare and Blue Cross Blue Shield of Alabama.
The Prescription Drug Monitoring Program (PDMP) for Alabama, which tracks the dispensing of prescription drugs and other controlled substances, and Medicare data revealed that Dr. Shelinder Aggarwal, 48, wrote more prescriptions for oxycodone, oxymorphone, hydromorphone, morphine, and other highly addictive opioid painkillers than any other physician in the U.S. in 2012.
According to a plea agreement filed by federal prosecutors, Aggarwal’s Chronic Pain Care Services clinic in Huntsville was nothing but a pill mill.
Court records state that in 2012, about 80 to 145 patients a day visited Aggarwal’s clinic, with Aggarwal seeing the majority of the patients and writing all prescriptions. First-time patient visits typically lasted five minutes or less, while follow-up visits took two minutes or less.
Aggarwal did not obtain prior medical records for his patients, court documents assert, and he did not treat patients with anything other than controlled substances. He often asked patients what medications they wanted and filled their requests, and he even prescribed drugs to patients he knew were using illegal drugs.
Moreover, federal prosecutors alleged Aggarwal did not take any appropriate measures to ensure that patients did not abuse controlled substances or dispense them illegally to others.
The plea agreement summarizes one of Aggarwal’s patient consultations that was secretly captured on video. The recording shows Aggarwal explaining how the Drug Enforcement Agency (DEA) viewed him as “the biggest pill-pusher in North Alabama” and that many of his patients were “dropping like flies, they are all dying.”
Federal prosecutors found that in 2012, Alabama pharmacies filled about 110,013 of Aggarwal’s prescriptions for controlled substances. That would equal about 423 prescriptions per day if he worked five days a week.
As to Aggarwal’s health care fraud scheme, he is charged with requiring patients to undergo unnecessary urine drug tests that he did not need or use in their treatment. Federal prosecutors assert that the tests he ran depended not on patients’ treatment, but on how much he could bill for tests. Even when test results showed patients to be using illegal drugs, Aggarwal would often ignore them.
Between January 2011 and March 2013, urine drug tests accounted for about 80 percent of paid claims Aggarwal submitted to Medicare and Blue Cross, for a total reimbursement of $9.5 million
“Aggarwal was trusted with resources to care for others and used that access to defraud the health care system, thus costing tax payers millions of dollars,” said FBI Special Agent in Charge Roger Stanton. “In addition, he directly contributed to the opioid drug epidemic which is plaguing our nation, and potentially endangered the lives of his patients. I applaud the work of my agents and our partners to shut down Aggarwal’s pill mill and hold him accountable for his actions.”
Aggarwal, who surrendered his Alabama medical license in 2013, agreed to forfeit his Huntsville pain clinic and $6.7 million. He earlier repaid $2.8 million to Medicare and $45,843 to Blue Cross, the U.S. Justice Department said. The plea agreement also calls for a 15-year prison sentence, to be approved by a federal judge along with the other terms of the agreement before it is final.
A joint investigation by The Associated Press and the Center for Public Integrity found that Alabama has the highest level of prescription opioid use in the country, and the drug companies that make the painkillers have hired an average of 18 lobbyists annually over the last decade to push their products.
According to the study, there were 5,128 deaths from prescription overdoses in Alabama from 2006 through 2014. The overdose death rate climbed 82 percent during that period. According to the CDC, most of the drug deaths were related to prescription opioids and heroin.