Press Release  Dorchester Doctor Pleads Guilty to Illegally Charging Patients Cash for Suboxone and Overcharging MassHealth for Vivitrol

Boston — A Dorchester doctor pleaded guilty in connection with a scheme to charge patients cash for opioid dependence treatment already covered by MassHealth, Attorney General Maura Healey announced today. As a part of sentencing, a judge has ordered him to resign his medical license.

Dr. Ashok Patel, age 62, of Hanover, and his medical practice, Ambama Clinic, each pleaded guilty in Suffolk Superior Court on Tuesday to charges of Larceny over $250 (2 counts), Medicaid False Claims (1 count) and Excess Charges (1 count). Patel was indicted in Suffolk Superior Court in September 2017.

“Dr. Patel illegally charged patients seeking treatment for substance use disorder and turned those away who could not pay,” said AG Healey. “We must continue to combat the opioid epidemic on all fronts, including going after those who seek to illegally profit off the opioid crisis and put up barriers to life-saving treatment.”

After Patel’s guilty plea was entered, Judge Robert N. Tochka sentenced Patel to three years of probation, the first four months of which he is on house arrest. The judge also ordered Patel to resign his license to practice medicine within 24 hours of sentencing. Patel and the Ambama Clinic must pay $15,855 in restitution to 30 MassHealth members from whom he solicited cash payments for substance use disorder treatments that were already covered by MassHealth. The defendants were also ordered to pay $10,610 in restitution to MassHealth for up-coding substance use disorder treatments as more expensive chemotherapy and fines and penalties in the amount of $56,534.

Patel, the owner of Ambama Clinic, treated MassHealth members diagnosed with substance use disorder with the prescription medications Suboxone and Vivitrol. The AG’s Office found that Patel and his clinic instituted a formal policy of not accepting MassHealth insurance as payment in full for substance treatment services, and instead charged MassHealth patients $75 weekly or $125 bi-weekly for Suboxone. MassHealth members unable to pay Patel and his clinic’s excess charges were turned away from the clinic and denied access to necessary treatment. 

The AG’s Office also found that between December 2014 and August 2016, Patel and his clinic solicited and received more than $15,000 in payments from MassHealth members for these substance abuse treatment services that were already covered by MassHealth. Additionally, Patel and his clinic submitted claims for reimbursement from MassHealth at a higher rate than permitted by improperly coding Vivitrol injections as chemotherapy, causing MassHealth to overpay Patel and his clinic more than $10,000.

By law, MassHealth providers are required to accept payments from MassHealth as payment in full for substance abuse treatment services provided to MassHealth recipients. Suboxone, as well as other formulations of buprenorphine, is used for the treatment of opioid dependence as it suppresses 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 has brought numerous criminal and civil enforcement actions against MassHealth providers who solicited and received cash payments from MassHealth members for covered addiction treatment and continues to actively investigate and prosecute such cases throughout the state.

In November 2017, AG Healey sent a letter alerting doctors who provide substance use disorder treatment that the office will take action against those who unlawfully require cash payments from MassHealth members for covered treatments.

This case was prosecuted by Assistant Attorney General Gregory H. Matthews and investigated by Investigator Steven Pfister, both of AG Healey’s Medicaid Fraud Division with assistance from Victim Witness Advocate Ellen Davis. MassHealth referred the matter to the AG’s Office and assisted in the case.

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