A prominent Indiana anesthesiologist performed medically unnecessary injection procedures, such as facet blocks and epidurals, on drug-dependent patients in exchange for prescribing them narcotics, according to a federal grand jury indictment charging Kamal Tiwari, MD, with healthcare fraud and 11 counts of unlawful drug distribution.

The frequency, dosage amounts and combinations of narcotic prescriptions Dr. Tiwari issued were "likely to cause and did cause those patients to submit to unnecessary injection procedures and other services, and to cause those patients to become dependent on" those procedures, according to the indictment. The anesthesiologist was arrested in Bloomington, Ind., this week after a more than 2-year investigation by state and federal authorities.

Dr. Tiwari has also been charged with defrauding several healthcare benefit programs. The indictment alleges that over a 5-year period, he received more than $21 million in payments from Medicare, Indiana Medicaid and Anthem Blue Cross Blue Shield alone.

Dr. Tiwari, who practices at the Pain Management Center of Southern Indiana and the Pain Management & Surgery Center of Southern Indiana, first caught the attention of investigators in 2007, when he was accused of reusing syringes during surgery. The state attorney general, FBI, HHS Inspector General and Indiana Medicaid Fraud Control Unit subsequently began investigating Dr. Tiwari for potential healthcare fraud.

"The allegations in this matter go well beyond the healthcare billing fraud we usually see," said Lamont Pugh, special agent in charge of the OIG's Chicago region, in a statement. "In this situation a physician not only used patients as pawns for profit, but actually compromised the health of some of Indiana's most vulnerable citizens."

Dr. Tiwari's attorney did not respond to a request for comment on the indictment. Dr. Tiwari faces a maximum sentence of 10 years' imprisonment and a $250,000 fine on the healthcare fraud count; 20 years' imprisonment and a $250,000 fine on the healthcare fraud resulting in serious bodily injury count; and 20 years' imprisonment and a $1 million fine on each of the drug distribution counts, according to the assistant U.S. attorneys handling the case.

Irene Tsikitas

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