BY
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, IN THE SPIRIT OF RETIRED DETROIT POLICE SARGENT WALTER R. CLEMENT BS., MS., MBA., HOWARD ADELGLASS, MD., BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
EXCERPTS FROM AUTHOR, PHYSICIAN, LAWYER
CATHLEEN LONDON, MD., JD
DEA, 50 YEARS OF FAILURE AND THE DIVERSION OF TRUTH
“The primary narrative driving policy is that the opioid epidemic is driven by overprescribing by clinicians, leading patients to become addicted. This has led to draconian laws that have harmed chronic pain patients and the use of invasive prescription monitoring programs throughout the country.
Christopher Russo, MD, a physician who has been on home arrest for over three years since his indictment, at which time the clinic he was employed by was shut down by prosecutors. Agents and prosecutors do not understand how medicine works. “[I]t’s easier to find ‘drug dealers with a pen’ if you simply define dealing as prescribing more than a certain amount—and busting doctors is certainly less risky for officers than going after violent cartel kingpins who run the fentanyl trade.”
He is accused of billing fraud, but he properly billed for a procedure done on multiple spine sites. Medical coding is quite convoluted. Physicians first must bill a code for the first procedure, and then if they do more designs the same day, there is a different code – which is precisely what this physician did.
He then prescribed hydrocodone for the patient following the procedure (ablation) as discomfort from nerve ablation is common. The indictment accuses him of fraudulent billing and prescribing without a legitimate medical purpose. This is typical of indictments. Meanwhile, this fellowship-trained physician is confined to home, has no source of income, and is left with nothing.
DOJ-DEA TARGETING (PAIN SPECIALISTS) AMERICA’S HIGHLY TRAINED DOCTORS FOR FEDERAL PRISON
On December 4, 2018, Dr. Christopher Russo and his co-defendants were indicted in a thirty-seven-page indictment. He was indicted on five counts of health care fraud, aiding and abetting. These allegations include that he prescribed opioids and other controlled substances to induce patients to attend reoccurring office visits and undergo medical procedures. Also alleged is that he submitted claims for procedures that were not necessary and ordered imaging and unnecessary diagnostic tests. Specific counts in the indictment:
Count 32. 4/25/2017 patient MM interlaminar lumbar/sacral injection $925 CPT code 62323
- Count 33. 11/16/2017 patient DS SI joint injection $1300 CPT code 27096
- Count 34. A separate count for the medication injected – dexamethasone J1100 $25.00
- Count 35. 3/14/2018 patient DS destruction lower spine facet joint CPT 64635 – code for the first vertebral nerve ablated $1650 and
Count 36. CPT 64636 $2475 code used for all the other vertebral nerves ablated the same day.
- Dr. Russo is a Board Eligible Anesthesiologist who went on to do a pain fellowship and a fellowship in interventional pain techniques. He sub-specializes in the spine. The procedures listed are precisely what he was trained to do. It is not the purview of the DEA nor the DOJ to determine whether these are medically necessary procedures – that is the jurisdiction of the state medical board.
Dr. Russo is a graduate of the University of Michigan Medical School. He completed his residency in Anesthesiology at Ann Arbor, did a two-year fellowship in Pain Medicine at the University of South Florida, and a Post Fellowship in Advanced Interventional Pain Techniques at Moffit Cancer Center in Tampa, Florida.
At the time of the indictment, Dr Russo was on the Board of Directors for the Michigan Society of Interventional Pain Physicians and an Assistant Professor of Surgery at Michigan State University College of Osteopathic Medicine. Dr. Russo is in the cohort that is defining pain management in medicine today.
The prescribing of narcotics for pain necessitates return visits. That is the standard of care. Controlled substance contracts require return visits for the prescribing of such substances and at this time, most state legislatures have enacted laws that require face-to-face visits every 28-30 days for any controlled substance prescription.
Michigan Public Act 247 of 2017 requires follow-up care for controlled substances. Medical billing is not a simple, straightforward endeavor. Physicians bill insurance as a courtesy to patients. Physicians are paid long after services are rendered, in a several months-long processes that requires multiple steps, any of which can go awry, delaying payment.
Current Procedural Terminology Codes (CPT) codes denote the procedures that were done, and they must be matched to the proper International Classification of Disease (ICD)-10 code.
That code is then submitted through a clearinghouse that reviews the claims and submits them in a standard format to the payor. The payer reviews the claim and rejects or pays an allowable amount. The claim adjudication is sent to the physician, whether this is the rejection of part or all of the claim.
CHRISTOPHER RUSSO, MD., ON TRIAL
When physicians set up fee schedules, they consider not just the cost of that particular service but all the work that is required to do that job, such as malpractice insurance expenses, rent, equipment, utilities, staffing – the cost of doing business. Also figured into the fee schedule is the fact that insurance companies only reimburse at “allowable” amounts. No physician sets their fee expecting to be reimbursed 100%. The majority of pain practices bill at three to ten times Medicare rates, with six to seven times Medicare rates being the average.
Dr. Russo’s fees for his spinal injections and nerve ablations were all reasonable. The indictment had separate counts for billing that is standard: physicians are required to bill for the substance injected in the spine (dexamethasone J1100) separately from the injection itself.
When doing ablations, there is a code for the first nerve ablation (64635 for $1650), which is billed at a higher rate than all the subsequent nerves ablated, which are billed as one code (64636).
The multiplier of 3 has been omitted from the indictment (so each additional ablation was $825, and the total charge for three additional nerves was $2475). Count 54 alleges that patient DS received 90 Hydrocodone on 3/14/2018. That is the same day the patient underwent nerve ablation of 4 nerves.
Procedures require pain medication post-procedure. It is not up to the DEA nor the DOJ to conclude that this is distribution outside of the usual course of professional medical practice when post-procedure pain management is the very definition of the appropriate medical use of narcotics.
In addition, this patient had been a stable patient of the clinic for over 3 years and had failed back surgery (post-laminectomy pain syndrome with lumbar fusion). This is the precise reason for the referral to a pain clinic.
“NOW HE IS FREE”
Dr. Russo used his extensive training to treat legitimate pain patients. The Government has charged Dr. Russo with practicing medicine and billing for his services.
These are not crimes. There is no billing fraud present here, these were medically necessary procedures that are commonly done, and pain medication was appropriately prescribed following the procedure, not as the Government alleges, outside the usual course of professional medical practice, but indeed in the course of the practice of medicine. “
FOR NOW, YOU ARE WITHIN
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REFERENCE:
SCOTT THOMAS, TAMPA, FLORIDA LOW HANGING FRUIT
