Transcript Life in the Fast Lane

Life in the Fast Lane
The Misadventures of an
Overprescriber
John Theodore Hancock
• Born 1961, Union City, California
• College- Southwest Adventist College,
Keene, Texas.
• Medical School- Loma Linda University,
California
• Residency- UT- Erlanger Medical Center,
Chattanooga, and ETSU, Tri-Cities
• (Did not finish. Resigned during PGY-2)
John Hancock
• Licensed to practice 1989.
• Emergency Department physician.
(Moonlighted during residency)
• Private Practice with Dr. Kinser.
• Established “Hancock Family Medical”
Hancock in 2004
Hancock Family Medical
AKA Cherokee Marina
A View from the Ground
Investigative Technique
• Surveillance
• Provided info regarding:
• Vehicles from great distances
• Number of people in one vehicle
• Wait times
• Parking lot behavior
• Did not provide any conclusive evidence
Investigative Technique
• Undercover Operators
• Failed to infiltrate
• DTF Agent compromised by Police
Officer/Patient
• Female informant compromised
• TBI Agent did not use b/c of TennCare
• Failure did provide evidence of
awareness by subject.
Investigative Technique
• Interviews
• Patients
• Reluctant
• Unwilling to give up source
• Employees
• Uncooperative
• Local PD/SO
• A lot of info, nothing written down
Investigative Technique
• Records
• No TennCare billing (cash)
• Medicare billing records (Statute of Limitations)
• Did not respond to request from worker
compensation, disability, or private insurers.
• Pharmacy billing for prescriptions * (PMP
would not be available until just before
indictment)
* formed the nexus of the health care counts
Investigative Technique
• Arrest
• Arrested June 11, 2003 on indictment from
Hamblen County Grand Jury charged with six
felony counts of “prescription forgery.”
• Entered plea on December 12, 2003 to two
misdemeanor “attempted forgery” counts.
• 2 year Probation with expungement (expires
12/12/05…remember this date)
• Surrender DEA cert.
• Attend drug treatment.
Medical Board Action/Inaction
• May 2004 – Probation after conviction for
“Attempted Forgery” (surrendered DEA cert in
plea deal)
• May 2005 – Failed drug screen (this was a
violation of both medical board and court
probation, medical board withheld information
from the court and delayed action against
HANCOCK)
• December 14, 2005 – Suspended for 4 months
followed by 5 more years of probation for drug
screen failure. (suspension was lifted without
reapplication.)
Medical Board Continued
• April 2006 – TMF notified the TMB that is
was “unable to continue advocacy status”
• So for seven more months HANCOCK was
allowed to continue to practice until.
• November 2006 – Ordered to surrender his
medical license.
Failure Summary
• The judicial system and the state’s medical
board failed to protect:
• Evelyn Lindsey
• Lisa English
• Lisa Ferrell
• Chester Thacker
• These four people died between
HANCOCK’S first arrest and the surrender
of his medical license.
Well what did work????
• Civil Attorney Method…
• Chasing Ambulances… or hearses in this
case.
Deaths
• Led to Search Warrant
• Focused the universe of information.
• Criterion
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Overdose proven by autopsy or Toxicology
Received prescriptions within days of death
Schedule II drugs
Purchased drugs with TennCare*
Important Breaks
• Death of Lisa English
• PC for 1st Search Warrant
• Death of James Brogan
• Gave us a “scene” to work
• Pharmacy Receipts and Office Receipts
• Autopsy confirmed multiple drug
overdose
• PC for 2nd Search Warrant
Mixed Blessing
• Internal Revenue Service Criminal
Investigation Division entered the
investigation.
• Currency
• No income taxes for five years
• Outstanding penalties
• Student Loan defaults
• PC for 3rd search warrant (This time we
took everything that was left.)
Investigative Technique
• Medical Records review
• 30 patients chosen from assembled data
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Frequent flyers
High dose narcotics+
Younger than 50
Dead (confirmed overdoses)
• Consultant
• MD at ETSU Medical School Clinical Practice.
• Previous history with substance abuse.
Investigative Technique
• Financial Records Analysis
• > 1 million in currency disposed of
• No tax returns filed
• SAR’s and CTR’s demonstrated frequent
conversions to money orders.
• Postal money orders purchased
• >214K in taxes owed.
Life after Medicine
• Fled to Texas
• Became “Dr. J” the science teacher
Investigative Technique
• Interviews
• Patients willing to throw him under the
bus.
• Employees willing to throw him under
the bus.
• Ex-Wife… willing to drive the bus.
Investigative Technique
• Federal Grand Jury Subpoenas
• Pharmacy Records (cash customer
records)
• Hospital Procedure Records
(demonstrated he was not doing
diagnostic studies)
• Specific Pharmacy Records
Paper Bonding
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Reading the Journals
Reading the medical records
Reading the other cases
Reading the “sticky notes”
Reading the medical school records
Reading between the lines….
The Indictment
• Health Care Fraud “resulting in death”
• Health Care Fraud
• Illegal Distribution of Controlled
Substances “resulting in death”
• Illegal Distribution of Controlled
Substances
• Money Laundering
• Tax Fraud and Evasion
The Trial
• Began July 6, 2009 after delays in January
and April.
• Jury seated and witnesses called during first
day.
• Jury was told to expect a three to four week
trial.
• Four alternate jurors selected because of the
anticipated length of the trial.
Prosecution Concepts
• Physician turned drug dealer.
• Portrait
• Poor student/resident.
• Heavy drug user.
• Complete disregard for patient’s problems.
• Complete disregard for employees and
family.
• Cash economy to avoid taxes.
Continued
• Submission of unlawful prescriptions to
pharmacies – “scheme to defraud” TennCare
(implicit falsehood that prescription was
medically necessary and properly
reimbursable – didn’t matter that HANCOCK
didn’t submit or get paid for claims.
• Prescriptions were illegal so scheduled
controlled substances were illegally
distributed.
Continued
• Since the prescriptions were illegal then the
cash was illegal (Money Laundering)
• Since he collected money he owed taxes.
• Since he changed to a cash economy and
hid assets, he intended to “evade” payment
of taxes he already owed.
Defense Contentions
• Well meaning just a little “liberal with his
prescription pad”
• Sympathetic to patient’s pain due to his own
painful medical conditions.
• “Gullible” believed his patients without
question.
• Not illegal to use cash. Just didn’t trust
banks.
Defense Continued
• Consultant did not see the patients, only
reviewed charts.
• Kept massive detailed medical records.
• Computer printed prescriptions to prevent
fraud.
• Did drug tests, pill counts, call backs…
discharged patients.
Trial Verdict
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Guilty of 102 of the 106 counts alleged.
Responsible for 3 patient deaths.
Not Guilty of 4 of the 106 counts.
Remanded to custody of the US Marshal
Service.
• Scheduled for sentencing December 7, 2009
• Mandatory min. of 20 years with life possible
• $2.5 million fine.
Aftermath
• 119 boxes of medical records to dispose of.
• Better training for medical
students/residents.
• Relationship with ETSU Colleges of
Medicine and Nursing.
• Drug Diversion Task Force participation.
Implications for
Compliance Officers
• Early recognition of drug and alcohol
problems among providers.
• Documentation checks and balances.
• Employee qualifications and background.
• Practice isolation.
• Patients… know them.
• “wagon circling”
Questions????
Special Agent Barry Carrier
Tennessee Bureau of Investigation
Medicaid Fraud Control Unit
207 North Boone Street, Suite 600
Johnson City, TN 37604
(423) 434-6424 ext 115
[email protected]