Robert Lowes
Sep 26, 2013

Full Medscape Article:  http://www.medscape.com/viewarticle/811735

“Brazen” is the word federal prosecutors use to describe a medical practice in Brooklyn, New York, that was shut down after perpetrating more than $77 million in Medicare fraud.

Its medical director and supposed owner, 58-year-old Gustave “Gus” Drivas, MD, almost never showed up at the office except to pick up checks, totaling $511,000, for lending out his Medicare billing number during the scam, according to the federal case against him. However, patients did not know he was a “no-show doctor,” as prosecutors called him, because Yuri Khandrius, a phlebotomist born in Ukraine, impersonated him all the way down to a forged signature in medical charts.

The practice, actually controlled by nonphysicians, also paid cash kickbacks to patients who received unnecessary or phantom medical services. During a single 6-week period in 2010, court-ordered surveillance equipment captured roughly $500,000 changing hands in a special “kickback room.” It was decorated with a Soviet Union propaganda poster from World War II of a woman putting a finger to her lips. It said “Don’t gossip” in Russian, which the practice’s many Russian-speaking patients would have understood.

Word got out, however, and federal agents busted the clinic as part of a nationwide Medicare fraud sweep in July 2010. Last week, Dr. Drivas was sentenced in a federal district court in Brooklyn to 151 months in prison — more than 12 years — after a jury found him guilty in April of healthcare fraud and healthcare fraud conspiracy. He was acquitted of conspiring to pay kickbacks to patients.

Twelve other individuals, including Khandrius, have been convicted of participating in the fraud scheme either through jury verdicts or guilty pleas. The judicial hammer put an end to what prosecutors called the defendants’ “ostentatious lifestyle,” characterized by expensive houses, a fleet of luxury cars such as a $280,000 Aston Martin, lavish parties, $30,000 watches, and plastic surgeries.

Once Again, Nonphysicians Were the Ringleaders

The Drivas case is another example of a criminal medical practice in which nonphysician ringleaders exploited the license of a physician.

Prosecutors said a 51-year-old Ukrainian immigrant named Irina Shelikhova, her son Maksim Shelikhov, and other family members joined Dr. Drivas in 2005 to found the Brooklyn clinic, which billed Medicare under a series of corporate names: Bay Medical Care, SVS Wellcare Medical, and SZS Medical Care. Shelikhova was not only one of the owners but also the “principal mastermind” who did the hiring and supervising, according to prosecutors.

Dr. Drivas admitted in a 2007 affidavit that he did not control Bay Medical Care and SVS Wellcare, even though he was designated their sole shareholder and director. SZS Medical Care was not incorporated until 2008. Its incorporation papers list Dr. Drivas and another physician as the only members of this professional limited liability company.

“Most of the professional corporations that list my name on the corporate paperwork and public records were secretly owned and controlled by laypersons who I now know are legally prohibited from owning and controlling medical practices,” Dr. Drivas wrote in the 2007 affidavit, referring to New York state law. The New York State Board for Professional Medical Conduct revoked his medical license in July on account of these misrepresentations.

Then again, misrepresentation was the clinic’s modus operandi, prosecutors said in court filings. “The clinic was conceived in fraud from the first moment of its existence and committed fraud until the last moment before being shut down by law enforcement,” they note. Shelikhova’s niece Elena Girenko, described as a key conspirator, told law enforcement agents that the clinic “was set up specifically to bill Medicare for fraudulent claims.” Girenko, Shelikhova, and her son Maksim all pleaded guilty in the case and await sentencing.

“At my huge regret, in the course of business, due to insufficient knowledge, many mistakes and violations were made, which led to breaking the law,” wrote Shelikhova in a letter to the court asking for “forgiveness and leniency.”

Tap Water Passed Off as Allergy Medicine

The government called the fraud at the Brooklyn clinic “brazen and wide reaching.” It cited a number of ruses:

• Khandrius, who impersonated Dr. Drivas, gave patients bottles of tap water that were said to be allergy medicine.
• Medicare does not pay for aqua massage, but the Brooklyn clinic called it physical therapy and billed for it anyway.
• Khandrius and a room full of other unlicensed personnel fabricated medical charts, completing physical therapy notes from a template “as if they had just examined the patient, or they were filling in what was to represent a completed physical therapy result.”
• Nonphysicians provided patient care willy-nilly. For example, Shelikhova’s boyfriend, a former truck driver with no medical training, conducted electrocardiogram and bone density tests.
• Another physician who worked at the practice and later pleaded guilty in the case admitted to upcoding office visit claims by inflating the amount of time he spent with patients.

The biggest ruse might have been the absence of Dr. Drivas from the clinic during its various incarnations. Prosecutors said almost 58,000 claims submitted to Medicare listed him as the “rendering physician,” yet “every single clinic employee who testified at the trial…said the same thing: Drivas was a no-show doctor who never treated patients.”

Dr. Drivas did appear regularly, however, to collect his compensation, which bank records put at roughly $12,000 per month on average. Sometimes, though, he said he was too busy to come to Brooklyn to pick up his checks, so Maksim Shelikhov would drive to Dr. Drivas’ home in Staten Island and hand deliver them.

All told, said prosecutors, the clinic submitted $77 million worth of bogus claims to Medicare, almost $21 million of that using Dr. Drivas’ billing number, and collected roughly $50 million.

Bighearted “Patsy” of a Criminal Cabal?

Sidney Baumgarten, an attorney for Dr. Drivas, sought leniency for his client in a sentencing memorandum to US District Judge Nina Gershon in Brooklyn after the April 2013 trial. Khandrius, the Drivas impersonator, had received an 8-year sentence. Baumgarten asked for a less severe prison term.

Dr. Drivas was the unwitting victim of a “Russian cabal” that forged his signature on “a panoply of documents” and misused his Medicare provider number, Baumgarten explained.

“He was perhaps grossly negligent in overseeing the clinics,” said Baumgarten. However, no evidence emerged during the trial to prove that Dr. Drivas “acted with an intent to defraud or cause Medicare a loss.”

Dr. Drivas reiterated those points in his own letter to the judge.

“I was lied too [sic] and cheated by [Maksim Shelikhov] and his family,” he said. “I was a patsy, taken advantage of because I am [a] trusting person.”

Dr. Drivas said he believed Shelikhov when he introduced Khandrius as a licensed physician assistant (PA). “The patients he saw were supposed to be billed under his PA provider number,” wrote Dr. Drivas, describing how he understood the practice arrangement.

The physician said he confronted Shelikhov after another physician told him in 2009 that a patient expected a kickback for visiting the practice. Shelikhov denied that such a scheme existed. “I was visibly angry and stated to him that if I find this to be true I will close this office and call the state,” Dr. Drivas wrote, adding that colleagues never reported anything suspicious after that.

A number of family medical problems, Dr. Drivas added, distracted him from paying more attention to the practice.

A bevy of family members, friends, and former patients also wrote letters to Judge Gershon in defense of Dr. Drivas. They called him a man of integrity and a bighearted physician who went out of his way to help others, whether it was treating first responders and victims of the 9/11 terrorist attack in New York City or distributing water and supplies on Staten Island after Hurricane Sandy.

“I truly believe Gus will be on the right track and continue to help people in need, and remain a good citizen and an asset to our community,” wrote a long-time friend and retired New York City police lieutenant.

For their part, federal prosecutors disputed Dr. Drivas’ claim that he was duped by Shelikhov and his family. “The entire scope of the fraud was reasonably foreseeable to him, and he should be held accountable for it,” they wrote.

In their recommendations for a stiff sentence, they noted that Dr. Drivas continued to break the law while on bond after his arrest, writing medically unnecessary prescriptions for oxycodone in exchange for cash at a clinic in Staten Island, they said.

“Given that Drivas engaged in this conduct while on pre-trial release,” prosecutors wrote, “it shows that he remained undeterred from illegal activities and unremorseful for what he had done at Bay Medical.

“The defendant lived a life of crime for more than 5 years at the expense of the American taxpayer.”