Dr. Jayam Krishna Iyer, 66, pleaded guilty to one count of health care fraud. She faces a maximum penalty of 10 years in federal prison, or 20 years, if her offense involves serious bodily injury, according to a press release from the Department of Justice’s Office of the U.S. Attorney for the Middle District of Florida.
As part of the plea, Iyer has agreed to surrender both her Drug Enforcement Agency registration number that she used to prescribe controlled substances and her Florida medical license, and to a permanent exclusion from the Medicare and Medicaid programs.
According to a press release, the plea agreement reveals that Iyer owned and operated Creative Medical Center located on Druid Road East in Clearwater. The center functioned as a pain management clinic.
Iyer billed Medicare and Medicaid for office visits, tests, and services provided to patients using her National Provider Identification (NPI) number, and wrote prescriptions for controlled substances, including oxycodone. She used Current Procedural Terminology (CPT) code 99213, which was used to bill for office visits for the evaluation and management of established patients, and required an in-person examination with the actual patient.
Beginning at least as early as July 2011, and continuing through December 2017, investigators say Iyer executed and carried out a scheme to defraud Medicare by billing for face-to-face office visits with Medicare beneficiaries, when, in fact, certain patients did not go to Iyer’s office and were not examined by her on the claimed dates; instead, family members of the patients went to Iyer’s office with notes requesting that Iyer issue and provide prescriptions, including for Schedule II controlled substances like oxycodone, to the family members, and in the beneficiaries’ names—and Iyer issued those prescriptions, the investigators said.
By doing so, Iyer was in violation of Florida law which requires doctors to perform an in-person office visit and examination of each patient before issuing Schedule II controlled substance prescriptions, the press release said. Iyer is also said to have falsified her electronic medical records, including vital statistics, to make it appear that the actual patient was present in her office for an office visit, when the patient was not. Iyer submitted at least $51,500 in these types of false and fraudulent Medicare claims, the Justice Department said.
This case was investigated by the Opioid Fraud and Abuse Detection Unit.