A former Huntsville physician, who was the nation’s highest Medicare prescriber of opioid painkillers at the height of his practice, pleaded guilty on Thursday, October 27, in federal court to illegally prescribing controlled substances and to health care fraud involving $9.5 million in unneeded and unused urine tests.
Shelinder Aggarwal, 48, of Huntsville, was charged with one count of distributing a controlled substance outside the scope of professional practice and not for a legitimate medical purpose in July 2012, and with one count of conspiring to execute a health care fraud scheme against Medicare and Blue Cross Blue Shield of Alabama between Jan. 1, 2011, and March 31, 2013. Aggarwal pleaded guilty to those charges. The sentencing date has not been set.
As part of a plea agreement Aggarwal reached with the government, he will forfeit his former clinic on Turner Street Southwest in Huntsville, along with $6.7 million. Aggarwal earlier repaid $2.8 million to Medicare and $45,843 to Blue Cross following audits, according to the plea agreement. The agreement stipulates a 15-year prison sentence. Aggarwal’s guilty plea was accepted Thursday, but the judge’s decision on whether to accept the 180-month prison sentence, has been reserved until Aggarwal’s sentencing hearing. The agreement between Aggarwal and the government is a binding plea agreement, so either party may withdraw from it if the court does not accept the stipulated sentence.
Aggarwal surrendered his Alabama medical license in 2013, along with his Alabama and federal Drug Enforcement Administration certificates to prescribe controlled substances, after the Alabama Board of Medical Examiners initiated an investigation.
Aggarwal was a pain management doctor who operated Chronic Pain Care Services in Huntsville. His medical practice was a pill mill, according to Aggawal’s plea agreement. It states that in 2012, about 80 to 145 patients a day visited Aggarwal’s clinic, with him seeing the majority of patients and writing all prescriptions. Initial patient visits typically lasted five minutes or less, and follow-ups two minutes or less. Aggarwal did not obtain prior medical records for his patients, did not treat patients with anything other than controlled substances, often asked patients what medications they wanted and filled their requests, prescribed controlled substances to patients who he knew were using illegal drugs, and did not take appropriate measures to ensure that patients did not divert or abuse controlled substances. The plea agreement summarizes an interaction with a patient, which was captured on video.
The agreement cites the Prescription Drug Monitoring Program for Alabama, which tracks the dispensing of controlled substances, as well as Medicare data, to document Aggarwal’s prescribing practices.
According to the PDMP, Alabama pharmacies filled about 110,013 of Aggarwal’s prescriptions for controlled substances in 2012. That would equal about 423 prescriptions per day if he worked five days a week, and resulted in about 12.3 million pills. The PDMP rated Aggarwal as the highest prescriber of controlled substances filled in Alabama in 2012, with the next highest prescriber writing a third as many prescriptions.
Medicare data shows Aggarwal was the highest prescriber in the United States of Schedule II controlled substances under Medicare in 2012. Schedule II substances include the opioid painkillers oxycodone, oxymorphone, hydromorphone and morphine.
As to Aggarwal’s health care fraud scheme, he pleaded guilty to requiring patients to undergo unreasonable and unnecessary urine drug tests that he did not need or use in their treatment. According to his plea, the tests he ran depended not on patients’ treatment, but on how much he could bill for tests. Aggarwal often ignored urine test results showing patients were using illegal drugs.
Between January 2011 and March 2013, urine drug tests accounted for about 80 percent of paid claims Aggarwal submitted to Medicare and Blue Cross, for a total reimbursement of $9.5 million. According to his plea agreement, “Aggarwal’s primary motivation for testing patients’ urine specimens, and submitting those claims for payment, was financial gain.”