News Stream

Revocation and $430,000 in fines and legal costs upheld for “massive” fraud by doctor

An appellate court upheld a decision by New Jersey Board of Medical Examiners to revoke the license of a physician who engaged in a “massive, fraudulent billing scheme” (In the Matter of Hessein). The October 18 decision also upheld fines and costs of over $430,000 issued by the board against anesthesiologist Amgad Hessein.

Hessein was the sole practitioner at a chain of pain clinics with offices in several New Jersey cities when, in 2009, a police detective who had received a tip concerning the theft of insurance payments sent a wire-wearing patient to see the doctor. Only two minutes into that undercover appointment, Hessein gave the patient an injection which would normally require a lengthy exam, then later created fictitious progress notes and billed the patient’s insurance for that lengthy, non-existent, exam.

Thus began Hessein’s legal troubles. In November 2010, an investigating detective entered Hessein’s home with a warrant at 9:00 in the morning and found a stack of completed bills for several patients dated for later that day.

Looking at a representative sample of just six patients, investigators found more than 250 incidences of visits billed when a patient had either not been scheduled for an appointment or where a patient stated that an appointment had not occurred. Hessein eventually pled guilty to criminal charges and was sentenced to eight years in prison, required to forfeit $2 million, and ordered to pay $235,000 in restitution.

New Jersey’s medical board opened its own disciplinary proceeding, adding many more charges of negligent and improper behavior, and eventually revoked Hessein’s license, fined him $130,000, and imposed legal costs of $308,000. Noting the extraordinary depth and breadth of Hessein’s fraudulent behavior, the board noted in its revocation decision that Hessein’s “patients do not have a medical record; they have documentation supporting [Hessein’s] massive, fraudulent billing scheme.”

Justifying the enormous fees and costs imposed on the doctor, the board said that, if it had prosecuted each instance of unprofessional, negligent, or fraudulent behavior separately, the fine would have amounted to more than $2 million. Hessein appealed, and the case went up to a state Superior Court, which issued a decision affirming the board.

On appeal, Hessein argued that the administrative law judge hearing his case should have given more weight to witnesses who testified in his favor about the charge of billing for non-existent appointments. But the court deferred to the administrative judge’s factual and credibility findings, noting that ample evidence supported that judge’s recommendation and the board’s ultimate decision.

In addition, the court noted, even if the administrative judge had placed more weight on the testimony of those witnesses, Hessein was still not able to provide adequate documentation for the services he supposedly provided, which placed his patients at risk of serious harm and indicated that he failed to provide sufficient information in order for his patients to provide informed consent.

The court also cited Hessein’s many breaches of the standard of care, noting that, “Among other things, appellant directed unlicensed employees to render physical therapy; performed conscious sedation procedures without having a certified person present to monitor the patient; prescribed opiates to a patient without any documentation that the medication was medically necessary; and failed to perform alcohol and substance abuse counseling when required.”

Lastly, the court rejected Hessein’s claim that the administrative judge was biased against him, noting that the substance of that bias claim was simply that the judge had made rulings adverse to Hessein, something that cannot be evidence of bias by itself.

Having rejected Hessein’s arguments, the court affirmed the revocation and fines issued by the board.