Attorney General James Announces Arrest Of Two Physicians On Charges Of Health Care Fraud At Opioid Mill

Physicians Allegedly Wrote Suboxone Prescriptions Without Medical Necessity to Lure Patients to Clinic and to Bill Medicaid for Unnecessary Services  

  Attorney General Letitia James announced the arrest and arraignment of Ilya Smuglin, M.D., 50, of Rego Park, New York and Clarisse Clemons, M.D., 63, of Rockville Centre, New York for allegedly conspiring to operate an opioid mill and fraudulently billing Medicaid. Smuglin and Clemons are charged with Criminal Sale of a Prescription for a Controlled Substance or of a Controlled Substance by a Practitioner or Pharmacist, Health Care Fraud in the First Degree, and Conspiracy in the Fourth Degree.     

“We will not tolerate attempts to fraudulently use the Medicaid program to take advantage of those suffering from addiction,” said Attorney General Letitia James. “New York is experiencing a serious opioid epidemic, and doctors that prescribe narcotics without proper screening procedures only deepen this crisis. We will continue to take on this crisis from every angle and that includes prosecuting doctors who abuse their duties and our trust.”   

The Attorney General’s Medicaid Fraud Control Unit (“MFCU”) filed papers alleging that Smuglin, Clemons, and other staff of the Miromedical P.C. and Ferrara Medical Care, P.C. clinics, conspired to create, enable, and foster an environment that encouraged and resulted in the excessive prescribing and sale of prescriptions for Suboxone. The prescribing and sale of prescriptions for Suboxone, a narcotic drug used to treat pain and opioid addiction, resulted in an influx of patients who were the means for the defendants and others to file and cause to be filed false Medicaid claims. These clinics, located at 903 Sheridan Avenue in the Bronx, and at 2738 Frederick Douglass Boulevard in Manhattan, operated as unauthorized, uncertified providers of substance abuse treatment services.   

State law mandates that substance abuse treatment programs be certified by the Office of Alcohol and Substance Abuse Treatment Services in order to treat those suffering from addiction. State and Federal Law further regulates how such treatment is to be conducted in order to heighten the chances of a successful recovery. 

"Anyone who takes advantage of vulnerable New Yorkers for their own benefit must be prosecuted to the fullest extent of the law,” said Department of Social Service Commissioner Steven Banks. “The conduct alleged in this case demonstrates a clear and unconscionable intent to defraud our social safety net as well as an absolute disregard for human dignity – and those who commit such crimes must be held accountable. We remain committed to collaborating with the Attorney General’s Office whenever necessary to prevent, identify, and report suspected fraud and abuse that amount to theft of public benefits.” 

The Attorney General’s office alleges that the physicians and their co-conspirators participated in a scheme to lure Medicaid patients to the clinics by paying kickbacks and offering prescriptions for Suboxone, an opioid that has potential for abuse. Once recruited, prosecutors allege that patients encountered the façade of a substance abuse treatment program. Appropriate and necessary medical histories were not always obtained, physicals and urine toxicology were not regularly performed, and patients were consistently provided with prescriptions for Suboxone at the maximum dose, without any effort to taper or wean the patient off the narcotic in violation of applicable treatment guidelines.   

As part of this scheme, prosecutors allege that Smuglin and Clemons regularly gave pre-signed and otherwise blank prescription pads to medical and non-medical staff within the clinics, which enabled them to hand out prescriptions, including ones for controlled substances, to patients without medical need. Once the Suboxone prescriptions were obtained, prosecutors allege that patients were regularly offered money from drug dealers inside and outside of the clinic, often in plain view of physicians and employees.   

Prosecutors further allege that relying on the accuracy of claims submitted for these Suboxone prescriptions, Medicaid and MetroPlus, a Medicaid managed care organization, paid pharmacies filling the prescriptions over $3 million in 2015 and over $2 million in 2016.   

Defendants Smuglin and Clemons were arraigned in New York City Criminal Court in Bronx County before Judge Wanda Licitra on Friday, May 3, 2019. The Defendants were ordered to surrender their passports and were released on their own recognizance. The case was adjourned to June 12, 2019. If convicted on the top charge, each defendant faces a maximum penalty of eight and a third to twenty-five years in state prison.      

The charges filed in this case are accusations. The defendants are presumed innocent until proven guilty in a court of law. 

These arrests are the latest example of Attorney General James’ commitment to tackling the opioid crisis from every angle. In March 2019, Attorney General James filed the nation’s most extensive lawsuit against the manufacturers and distributors of opioids and over the past two weeks, the Attorney General’s office has taken down two major drug trafficking rings responsible for flooding our communities with these dangerous drugs. 

The Attorney General thanks the U.S. Department of Health and Human Services, Office of the Inspector General, and the New York City Human Resources Administration (“HRA”) for their valuable assistance throughout the investigation. In addition, the Attorney General thanks the New York State Department of Health, Bureau of Narcotic Enforcement, the New York State Office of Alcoholism and Substance Abuse Services, and the New York State Office of the Medicaid Inspector General.    

New Yorkers can report suspected fraud to the Attorney General’s toll-free Medicaid Fraud Hotline, at (800) 771-7755 or online at ag.ny.gov/medicaid-fraud/contact.

Comptroller Stringer Audit Reveals that ACS Fails to Ensure Children are Placed in Fully Certified Foster Homes

ACS has no procedures to monitor the certification of foster homes before they receive foster children

81 percent of sampled certified foster homes eligible to take care of New York City foster children were missing evidence of mandated training, medical exams and TB screenings, and background checks

ACS’s limited reviews failed to uncover homes that were erroneously certified

Stringer calls on ACS to ensure foster care providers are not in operation without fully meeting agency standards

  Comptroller Stringer released an audit of the Administration for Child Services (ACS), which found that the agency performs lackluster oversight of the foster system that leads to the improper certification of foster homes across New York City. The report found that 81 percent of sampled foster home files in Fiscal Years 2017 and 2018 were missing evidence of one or more certification requirements – such as mandated training, medical exams, background checks, and clearances. While ACS does review some foster home certifications, it does that only after children have already been placed in those homes and even then, the Comptroller’s audit found that nearly one-quarter of homes that ACS deemed compliant should not have been certified.

“Every child should grow up in a safe and supportive home, and high standards for children under the City’s care are non-negotiable,” said Comptroller Stringer. “But our audit shows that ACS’s lack of oversight enables a deficient foster care system, where children can be placed in homes that don’t measure up or meet their needs. What’s worse is that ACS is deflecting its responsibility to help ensure that foster homes are safe and supportive before a child even enters the picture. We have to do better for our youngest New Yorkers and ACS needs to immediately embrace meaningful change.”

While ACS contracts with providers to manage the process of certifying foster homes and to place and support children in foster care, ACS remains responsible for managing the foster care services – and is considered the temporary custodian of children in the foster programs. Potential foster parents and homes must meet various prerequisites set by the State Office of Children and Family Services to become a certified foster home including completing prescribed foster training, medical exams included a tuberculosis test, background clearances from the FBI and State, and a home study. Yet, ACS failed to help ensure that every foster home was fully and correctly certified to take care of children, before children were placed in their care.

• In particular, Comptroller Stringer’s audit revealed that 89 (81 percent) of 110 sampled foster home files for Fiscal Year 2017 did not demonstrate that all required training, medical checks, background checks, and references were completed before the homes and families were certified to take care of children.
• 43 erroneously certified homes were missing multiple requirements.
• Of the total 89 non-compliant homes uncovered, 80 had foster children residing in them – and more than half had been taking of care children without proper evidence of certification for hundreds of days.
• In an in-depth review, the audit found that nearly half of these certified homes were missing evidence of mandatory training and/or medical clearances. Over a dozen certified homes were missing evidence that FBI or Statewide Central Register (SCR) clearance and/or references were obtained.

Examples of Certified Foster Homes Missing Crucial Checks

In one example, a foster home in the audit sample was missing the required medical and TB screenings along with a home study narrative – yet had fostered children since October 2013. Moreover, while the home’s most recent certification had expired on January 6, 2017, a child was still placed with the foster parent three months later (April 4, 2017) and resided there for nearly a year.

In another example, our office’s review of an ACS provider’s file for a certified foster family caring for three foster children revealed that it was missing medical clearances and TB screenings for four of the five household members who resided in the home, evidence of training, and references.

In a third example, a child was placed into an emergency kinship home and resided there for over a year while the home was out of compliance. Emergency kinship homes are required to undergo an emergency home study prior to the child’s placement and a full home study within 90 days after placement – yet the home study had not been completed at all for over 11 months after the child’s placement.

ACS Fails to Catch Errors in Its Own Audits

ACS performs annual audits of contracted providers’ foster family files only after children have been placed in the foster homes, and only for newly certified and first-time re-certified foster families, to assess whether the provider is placing children into certified homes and to alert ACS if there are any deficiencies with the certification process employed by the foster care provider.

However, Comptroller Stringer’s review found that ACS’s annual audits of foster family files are inadequate, poorly conducted, and do not provide appropriate oversight of the certification process. As a result, ACS’s audit findings in this area were found to be incorrect in roughly 24 percent of foster files reviewed. Moreover, ACS did not consistently ensure that deficiencies found in the agency’s own annual audits were corrected – and as such, 7 non-compliant homes found by ACS were allowed to continue operating for up to 484 days.

Audit Recommendations

To address the lack of oversight and problems uncovered by the audit, Comptroller Stringer is calling on ACS to:

• Develop a review process that ensures foster care providers do not certify prospective foster care families until the providers have collected the required evidence to demonstrate that the families have met the City and State’s requirements.
• Set deadlines for providers to correct all deficiencies identified in the annual audits.
• Implement procedures that require staff to follow-up on the annual audits to ensure that providers either correct all deficiencies identified in those audits or work with ACS to develop a plan to correct them.
• Update and adhere to its audit methodology so that it checks for all documents required for a certification, includes all homes as part of its audit size, limits the advance notice it provides, independently confirms information about the foster family status of families selected for audit, and ensures that it selects the required number of families to audit.

To read the audit report, click here.

1 BRONX FESTIVAL PRIDE SUNDAY JUNE 23, 2019

ABOUT 

I N C L U S I V I T Y . C O M M U N I T Y . A W A R E N E S S . E M P O W E R M E N T 

The 1 Bronx Pride Festival promotes inclusion, community, and dialogue and works toward a future without discrimination where all people have equal rights under the law. We do this by producing Pride events that inspire, educate, and celebrate our diverse Bronx community.

The 1 BRONX PRIDE FESTIVAL is produced by the Third Avenue Business Improvement District in partnership with Destination Tomorrow, Boogie Down Pride, OUT Bronx, the LGBTQ Caucus of the Bronx Borough President, Dancing in the Streets, Bronx Academy of Arts and Dance, and Clearview Festivals. The Third Avenue Business Improvement District (aka Third Avenue BID), established in 1988, promotes the growth, vitality and visibility of the Bronx’s most trafficked commercial corridor. The organization is the Bronx’s oldest BID and serves over 200,000 individuals daily. Organizational programs include economic development, real estate advisory and retail services, sanitation and security departments that augment the city’s own services, small business development services, streetscape and open space improvements, horticulture installations, robust public programming, event planning, and visitor services. The catchment area includes over 200 businesses, expected to grow to 900 businesses by 2019, Roberto Clemente Plaza, Triangle Equity Plaza, the HUB Transportation Center, Lincoln Hospital, Metropolitan College of New York, and several arts and cultural institutions. The Third Avenue Business Improvement District also administers merchant organizations in Port Morris along Bruckner Boulevard to 138th Street. MISSION Our mission is to keep one of New York City’s most trafficked commercial districts clean, safe, attractive and well programmed for businesses, employees, community residents, and visitors while leading a mission-driven campaign to demand equity for the South Bronx.

The 1 Bronx Pride Festival culminates on June 23, 2019 at 149th Street and Third Avenue in the Bronx with a multi-block street festival that celebrates the diversity of the borough. The festival feeds on the energy of workshops, trainings, gallery openings, street performance, and film screenings which lead to performances on two stages and at Roberto Clemente Plaza.

EVENTS 

The 1 Bronx Pride Festival is more then just a one-day event. The festival's purpose is to celebrate and empower area residents and neighbors through a series of community-based productions which then culminate in a spectacular multi-block street festival on Sunday, June 23, 2019. The festival and events leading up to it promote inclusivity, community, awareness, and empowerment.

JUNE 

1st   Hate Has No Business Here Summer launch of a campaign to promote inclusivity and cultural competency training to South Bronx Small businesses.

3rd   Pride Flag Raising + 

Pride Lighting of Bronx Buildings 851 Grand Concourse Bronx, New York

4th   LGBT Film Screening 

2825 Third Avenue, 3rd Floor Bronx, New York 10455

5th   Bronx Borough President and Allies LGBT Pride Celebration, 

6:00pm Billy's Sports Bar River Avenue at 161st Street

13th   Para Roberto: Cultura, 6:00pm 

Salsa Night on Roberto Clemente Plaza 

21st   Strike a Pose - Cocktails and Culture Bronx Museum of the Arts 

1040 Grand Concourse Bronx, NY 10456

22nd   My Big GAY Bronx Brunch Suyo 

1401 Plaza Drive Bronx, New York 10452

23rd 1 Bronx Pride Rally, March and Festival 

Rally: Bronx Borough Hall

March: 161st Street to Third Avenue Festival: 

149th Street and Third Avenue

1 Bronx Pride Festival

    149th + third Avenue
SUNDAY JUNE 23,2119

A production of the Third Avenue Business Improvement District.

Third Avenue Expands Hate Has No Business Here Campaign The Third Avenue Business Improvement District in partnership with 21 business improvement districts throughout New York City and the New York City Commission on Human Rights is humbled to expand the Hate Has No Business Here Campaign. The campaign has a simple message: to inspire a conversation to combat narratives that purport racism, xenophobia, homophobia, and misogyny, especially as they impact our City’s small business community. The campaign includes small business trainings center on cultural competency and inclusivity. #NOHATEHERE

News From Councilman Mark Gjonaj,

This is the time to come and ask your questions.

If you have any questions about your Post Office or Mail Delivery in 10460, 10461 or 10462, We will have Area Managers and Customer Managers for 10460, 10461 and 10462 as guest speakers

Also reports from local elected officials.

Bronx Borough President Ruben Diaz Jr. - Construction Career Information Session - MAY 7TH

Castle Hill Little League Parade and Presidential First Pitch

 The Annual Castle Hill Little League Parade from Castle Hill and Lafayette Avenues to the ball field on Zerega Avenue took place Saturday. Councilman Ruben Diaz Sr. was a prime sponsor of the parade and league itself. As the teams lined up to march many took their photo with Councilman Diaz Sr. as you see above with the Aquinas High School marching band, and below. The estimate of marchers by the 43rd Precinct was close to five-hundred people who marched up Castle Hill Avenue turning right on Newbold Avenue to Zerega Avenue where the field is located. There was a police escort to the field where Bronx Borough President threw out the first pitch of the day. Below are photos of the parade, and ceremony at the field. 

Councilman Diaz Sr. led the parade that was given a police escort to the stadium. The parade stretched as long as three blocks, and crossed over the Bruckner and Cross Bronx Expressways in route to the ballfield.

Bronx Borough President Ruben Diaz Jr. speaks about his little league days pointing to how far he could hit the ball.

Above - Some on the field activities.

Below - A little father son game of catch.

Bronx - BP Diaz Jr. goes into the motion.

Below - BP Diaz Jr. throws out the first pitch. 

State Senator Alessandra Biaggi gives 50th Annual Lehman College Memorial Lecture, and supports CUNY Professors

  It was the 50th Annual Herbert H. Lehman Memorial Lecture with Lehman College President Jose Luis Cruz giving the opening address, and then introducing State Senator Alessandra Biaggi for the Memorial Lecture. 

 Senator Biaggi began her speech with memories of her grandfather former Congressman Mario Biaggi, with some family history of how he wound up running for elected office. In her speech she parrelled her calling to run for office to that of her grandfather. She said that one is not to think of themselves, but they can help the community as a whole. 

 She went on to say that while there are now thirty-nine Democratic State Senators things have not changed as she thought they would. There is still much to little sharing of power while you have to vote for something that has other items you might not vote for is attached to it. 

 Senator Biaggi mentioned how her campaign went by knocking on doors, talking to people to see what they wanted from their representative, and trying to be what the people wanted her to be. She mentioned that she is a survivor of child sex abuse, and spoke of some of the new legislation passed in 2019 with the new Democratic State Senate.

 Then Senator Biaggi spoke of changing things in Albany such as the budget process. The Courage, Disruption, and Resilience that is needed to change the way things are done in Albany, and how those three things can change the old way things get done into a newer better way. 

She ended by saying that the tide is always right to do what is right, by rejecting the status quo in Albany. 

Afterwards Senator Biaggi went outside to protest on campus with professors who want higher wages claiming that the current wage scale is to low for them. 

Above - State Senator Alessandra Biaggi gives the 50th Annual Herbert Lehman Memorial Lecture.

Below- After the lecture Senator Biaggi went outside to call for higher wages for CUNY professors.