- Office of Attorney General Maura Healey
Media Contact for Dorchester Doctor Indicted for Illegally Charging Patients Cash for Suboxone Treatment
Boston — A Dorchester doctor has been indicted in connection with charging patients cash for opioid addiction treatment already covered by the state’s Medicaid program and illegally profiting off of vulnerable patients in Massachusetts, Attorney General Maura Healey announced today.
Dr. Ashok Patel, age 61, of Hanover, was indicted today by a Suffolk County Grand Jury on charges of Larceny over $250 (2 counts), Medicaid False Claims (1 count) and Excess Charges (1 count). He will be arraigned in Suffolk Superior Court at a later date. Patel’s company, Ambama Clinic, Inc., was also indicted on the same charges.
Patel is a MassHealth primary care provider and owner of Ambama Clinic, Inc. located on the Carney Hospital campus in Dorchester. At his clinic, Patel provided MassHealth members diagnosed with opioid addictions with the prescription medications Suboxone and Vivitrol.
“We allege that this doctor illegally charged patients for substance use treatments already covered by insurance,” said AG Healey. “This conduct undermines access to the medical care needed to break the cycle of addiction and we will take immediate and aggressive action against those who seek to illegally profit off this crisis.”
MassHealth providers are required by law to accept payments from MassHealth as payment in full for substance use treatment services provided to its members. Suboxone and other formulations of buprenorphine are used for the treatment of opioid addiction as they suppress withdrawal and cravings for opioids. Vivitrol is an injectable prescription medication that blocks the effects of opioids and is used to treat drug or alcohol dependence. The AG’s Office received a referral from MassHealth about the matter.
The AG’s investigation revealed that Patel allegedly instituted a formal policy of not accepting MassHealth payment for substance use treatment services, and instead charged MassHealth patients $75 weekly or $125 bi-weekly for Suboxone.
Investigators determined that between December 2014 and August 2016, Patel solicited and received more than $15,000 in payments from MassHealth members for services that were covered by MassHealth. The investigation revealed that Patel “double dipped” by submitting more than $12,000 in claims for reimbursement from MassHealth for the same treatment services that MassHealth members had already directly paid Patel for in cash.
The AG’s Office alleges that MassHealth members unable to pay Patel’s excess charges were turned away from his clinic and did not receive necessary substance use treatment from Patel.
The investigation also exposed Patel’s upcoding scheme related to Vivitrol. Patel allegedly submitted Vivitrol reimbursement claims at a higher rate than permitted by improperly coding Vivitrol as chemotherapy, causing MassHealth to overpay Patel more than $10,000.
All of these charges are allegations and the defendant is presumed innocent until proven guilty.
This case is being prosecuted by Assistant Attorney General Gregory Matthews and was investigated by Investigator Steven Pfister, both of AG Healey’s Medicaid Fraud Division, with assistance from MassHealth.