Rego Park physician arrested in opioid Medicaid fraud scheme

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A Rego Park doctor was one of two individuals arrested for allegedly conspiring to operate an opioid mill and fraudulently billing Medicaid, state Attorney General Letitia James announced on Monday.

Ilya Smuglin, M.D., 50, and Clarisse Clemons, M.D., 63, of Rockville Centre were charged with criminal sale of a prescription for a controlled substance or of a controlled substance by a practitioner or pharmacist, health care fraud and conspiracy.

The Attorney General’s Medicaid Fraud Control Unit (MFCU) filed papers alleging that Smuglin, Clemons and other staff of the Miromedical P.C. and Ferrara Medical Care P.C. clinics, conspired to create, enable and foster an environment that encouraged and resulted in the excessive prescribing and sale of prescriptions for Suboxone, a narcotic drug used to treat pain and opioid addiction that has potential for abuse, which resulted in an influx of patients who were the means for the defendants and others to file and cause to be filed false Medicaid claims.

“We will not tolerate attempts to fraudulently use the Medicaid program to take advantage of those suffering from addiction,” said James. “New York is experiencing a serious opioid epidemic, and doctors that prescribe narcotics without proper screening procedures only deepen this crisis. We will continue to take on this crisis from every angle and that includes prosecuting doctors who abuse their duties and our trust.”

According to charges, Smuglin, Clemons and their co-conspirators allegedly participated in a scheme that lured Medicaid patients to their clinics, located in Manhattan and the Bronx, by paying kickbacks and offering prescriptions for Suboxone.

Once recruited, prosecutors said, patients allegedly encountered the façade of a substance abuse treatment program.

During this time that appropriate and necessary medical histories were allegedly not maintained, authorities reported, physicals and urine toxicology were not regularly performed. Patients, nonetheless, were consistently provided with prescriptions for Suboxone at the maximum dose, without any effort to taper or wean the patient off the narcotic in violation of applicable treatment guidelines.   

As part of this scheme, prosecutors say, Smuglin and Clemons allegedly gave pre-signed and blank prescription pads to medical and non-medical staff within the clinics, which enabled them to hand out prescriptions, including ones for controlled substances, to patients without medical need. Once the Suboxone prescriptions were obtained, patients were allegedly offered money from drug dealers inside and outside of the clinic, often in plain view of physicians and employees.

Prosecutors say that relying on the accuracy of claims submitted for these Suboxone prescriptions, Medicaid and MetroPlus, a Medicaid managed care organization, paid pharmacies filling the prescriptions over $3 million in 2015 and over $2 million in 2016.

Both Smuglin and Clemons were arraigned before the New York City Criminal Court in Bronx County on May 3, where they were released on their own recognizance and ordered to surrender their passports. Both are due to return to court on June 12.

If convicted, Smuglin and Clemons each face between 8 1/3 to 25 years in state prison.

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