Alleged Fraud At Drug Treatment Clinics May Harm Patients

Second in a two-part series.

BOSTON — The criminal investigation of insurance fraud by a Brookline doctor has caused the collapse of his statewide chain of drug treatment clinics.

Many of those patients were dependent on a newly approved, anti-addiction drug called Vivitrol. Since the clinics were the prime supplier of the drug, professionals are warning of a potential spike in overdoses and relapses.

'A Big Mistake'

Maybe this was "just a big mistake," as the defense attorney for Dr. Punyamurtula Kishore plead before the court last week. His client was charged with Medicaid fraud.

"Big" is certainly the right adjective for Kishore's story.

"It's just mind-blowing," said Joe Desroches, who worked in Kishore's Weymouth clinic. "This is why I don't understand why he had to double-dip and kickback and all that stuff: We were making him enough money. Just between us and Woburn alone, he was making a million and a half a year, legally — legal money, a million and a half a year — just between our two offices. Never mind the other 25 that he had."

Starved of state reimbursements, Kishore started closing clinics without notice over the summer.

Joanne Carviello, a technician at Kishore's Woburn clinic until it was shuttered, said the clinic was often busy.

"You know it's a huge company, we've got tons of patients, it's a big place, it's a lot of offices," Carviello said.

Carviello should have been talking in the past tense, as Kishore's climb skyward had hit a snag. It was a big ladder, with lots of entities and associations he had formed along the way.

It turns out Kishore is also the president and founder of the American College of Addiction Medicine, in Brookline, and he founded the National Library of Addictions in Brookline Village.

But the attorney general says that library was used to pay kickbacks to the director of a sober house in return for sending urine samples for screening.

"That was the majority of our work," Carviello said.

Sixty percent of the income to Kishore's chain of clinics came from drug testing, she said. And most of that came from "all the urine [samples] that we did for all of the sober houses," Carviello said.

The "sober houses," otherwise known as halfway houses, were testing residents to make sure they were clean of drugs.

A Fraud Investigation

According to the attorney general, Dr. Kishore paid $2,500 a month to the president of the Fresh Start Recovery Coalition, a Malden company that ran "sober houses" across the state. In return, the company's president, Damion Smith, allegedly sent residents to Kishore for drug testing. The purported scheme involved $597,000 in claims billed to MassHealth, the state's Medicaid program. The attorney general calls it fraud.

Each drug screen cost $100 to 200. Carviello, who did the testing for Kishore, says the president of those halfway houses was "testing crazy — five or six times a week."

That was crazy, Carviello and her co-workers thought, because opiates remain in the body for three to four days. Even ordering three tests a week should have been too much.

Kishore never received a state license from the Department of Public Health to run addiction treatment programs.

"You're not going to learn anything new on Tuesday that you didn't know on Monday," Carviello said, "unless they used that very night before. And if they did, there's no sense testing on Wednesday because it's still in your system."

Others, too, question the need for so many tests. Joanne Peterson runs Learn To Cope, a support group for families of drug addicts on the South Shore. She says she became suspicious the first time she heard Dr. Kishore pitching his treatment plans to parents.

"People would say ... 'What do we do? How do we afford it?' " Peterson said. "He was like, 'Have them come see me, I can get anyone on MassHealth — anyone. Don't worry about it.' And I was like 'Oh my God. Red flag.' "

That was 2004.

By June of this year, MassHealth began withholding reimbursements for Kishore's chain of clinics — a criminal investigation had begun. At the Woburn office, supervisors told the staffers it was merely an audit when they asked for 500 charts and lab work. But when she got the list of the names her supervisors needed to provide the state, Carviello saw the light.

"The top of the paper said 'Subpoena,' so, that wasn't very bright," Carviello said, laughing.

The joke turned out to be on both the employees and the patients.

Patients Without Clinics

Starved of the state reimbursements, Kishore started closing clinics without notice over the summer. At those that remained open, he stopped paying his employees. When he was arrested last week, the last of his clinics shut down, as did the supply of the anti-addiction drug Vivitrol.

So why, with a potential crisis on its hands and knowing Kishore's clinics were collapsing, didn't the state step in sooner to avert the coming crisis for addicts who were about to be cut off from treatment?

That was the question posed Monday to the state secretary of Health and Human Services, Dr. JudyAnn Bigby.

"I can't comment because of the investigation of a fraud that's going on and the other agencies that are involved in the investigation," Bigby said.

If Bigby was suggesting the attorney general's office was tying her hands, a spokesman for the attorney general had another position.

"We worked cooperatively with MassHealth," the spokesman said, "to ensure they were aware of our investigation well in advance of last week's legal action."

The state says it's trying to find and coordinate alternative treatment for Kishore's patients. And, WBUR has learned that Dr. Kishore never got a state license from the state Department of Public Health to run addiction treatment programs.

Meanwhile, at Kishore's businesses in Brookline Tuesday, eviction notices were posted on closed doors.

His lawyer didn't return phone calls requesting comment and at his home, no one answered. The dry cleaning sat out front in stenciled packaging that read "We love our customers."

Part One:

Alkermes maintains a database of treatment centers and physicians who have registered as providers who are willing to give treatment with Vivitrol. Individuals who need assistance in locating a health care provider who offers Vivitrol therapy can call 1-800-VIVITROL (1-800-848-4876).

According to the Massachusetts Executive Office of Health and Human Services, PMA patients enrolled in MassHealth should contact MassHealth Customer Service at 1-800-841-2900 to locate a physician who participates in the MassHealth Primary Care Clinician Plan or one of its managed care organizations.