Clearwater Doctor Pleads Guilty To Health Care Fraud

Tampa, Florida – Dr. Jayam Krishna Iyer (66, Clearwater) today 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. As part of the plea, Iyer has agreed to surrender both her DEA 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 the plea agreement, 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. As an approved Medicare provider, Iyer also agreed to provide truthful information and to not make any materially false statements or representations in connection with the delivery of or payment for health care benefits.

Beginning at least as early as July 2011, and continuing through December 2017, 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. Iyer thereby violated a Florida law requiring doctors to perform an in-person office visit and examination of each patient before issuing Schedule II controlled substance prescriptions. Iyer also 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.

This case was investigated by the Opioid Fraud and Abuse Detection Unit. On August 2, 2017, Attorney General Jeff Session announced the formation of the Opioid Fraud and Abuse Detection Unit, a Department of Justice pilot program to utilize data to help combat the devastating opioid crisis that is ravaging families and communities across America. The unit focuses specifically on opioid-related health care fraud using data to identify and prosecute individuals that are contributing to the prescription opioid epidemic. The case was investigated by the Federal Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, the Drug Enforcement Administration, and the Florida Office of Attorney General’s Medicaid Fraud Control Unit. It is being prosecuted by Assistant United States Attorney Kelley Howard-Allen.