Bloomington Man Sentenced on Health Care Fraud, Drug Distribution Charges
U.S. Attorney Says Case is Another Result in Fight Against “Culture of Corruption” in Indiana

INDIANAPOLIS—The United States Attorney’s Office announced that Kamal Tiwari, age 60, of Bloomington, was sentenced this morning to 42 months (three years and six months) in federal prison by District Court Judge Sarah Evans Barker. The defendant was also ordered to pay restitution in the amount of $1,299,866.54. This follows Tiwari’s admission of guilt to charges of health care fraud and unlawful drug distribution in March of this year.

“Today’s sentencing holds accountable someone who betrayed both his profession and the trust of his patients, endangering lives and defrauding taxpayers of more than a million dollars,” said U.S. Attorney Joseph H. Hogsett. “While we argued this morning in favor of a sentence that we believe was befitting of the crimes committed, we respect the Judge Barker’s decision and will continue to work with our law enforcement partners to make whole the victims of Mr. Tiwari’s actions.”

Tiwari was a medical doctor who specialized in anesthesiology in the Bloomington area, and he possessed a federal Drug Enforcement Administration license to prescribe controlled substances. In the late 1990s, Dr. Tiwari began to focus his medical practice in “interventional pain management,” a specialty of medicine which includes a wide variety of therapies, often involving combinations of injection procedures and opioids.

Dr. Tiwari’s practice was based out of two Bloomington businesses: the Pain Management Center of Southern Indiana, and the Pain Management & Surgery Center of Southern Indiana, Inc. Patients were examined at the Pain Management Center, and then procedures were performed at the Surgery Center. Both businesses shared the same office suite.

Almost all health insurers, including Medicare, Medicaid, and Anthem, require that health care services be “medically necessary” in order to be reimbursed. From January 2007 through December 2007, Dr. Tiwari now admits that he engaged in a scheme to defraud Medicaid, Medicare, and Anthem by performing numerous medical procedures on patients that were not medically necessary, including such injection procedures as facet blocks, epidurals, and radiofrequency ablations.

These procedures both exceeded the standard of care in interventional pain medicine practice and also carried risks such as serious infection, as well as other side effects, from an excess amount of steroids. Dr. Tiwari has admitted that all of this was done for the purpose of increasing the revenue of his medical practice.

In addition, as a component of this scheme to defraud, Dr. Tiwari plead guilty to providing certain patients opioid prescriptions that exceeded any legitimate purpose. These prescriptions included such drugs as Percocet, Oxycontin, oxycodone, and methadone. These drugs, along with the excess steroids from the unnecessary procedures, caused some patients serious bodily injury.

“The epidemic problem of prescription drug abuse begins with overprescribing and ends by exacting a huge toll on our society,” said Indiana Attorney General Greg Zoeller, whose Medicaid Fraud Control Unit (MFCU) participated with federal authorities in the investigation of Tiwari. “Actions against physicians who abuse their position of trust are part of the solution to this problem, along with public education and treatment of drug addiction.”

“The Department of Health and Human Services-Office of Inspector General is committed to ensuring that individuals who relentlessly prey upon our most vulnerable populations by committing fraud upon our federal health care programs while simultaneously harming those who are placed in their trust are brought to justice,” said HHS-OIG Special Agent in Charge Lamont Pugh, III.

The total amount of money that Dr. Tiwari earned from these medically unnecessary procedures in 2007 from Medicaid, Medicare, and Anthem patients amounted to $1,299,866.54, all of which must be repaid.

This case was the result of significant effort on the part of the prosecution team from the U.S. Attorney’s Office that included Assistant U.S. Attorneys Winfield D. Ong, Bradley P. Shepard, and Shelese M. Woods. The resolution of this case comes as part of the United States Attorney’s Office’s effort to focus on combating fraud and waste in Indiana.

The charges brought against Dr. Tiwari stemmed from an extensive investigation by the Inspector General of the United States Department of Health and Human Services, the Indiana Medicaid Fraud Control Unit, Office of the Indiana Attorney General, and the Federal Bureau of Investigation.