A Roanoke medical practice gamed the system to illegally collect hundreds of thousands of dollars in reimbursement treating severe asthma, according to federal charges.
Allergy and Asthma Associates Inc., represented by office manager Isis M. “Mary” Abraham, pleaded guilty Tuesday in U.S. District Court in Roanoke to felony health care fraud.
Abraham oversaw a scheme from 2010 to 2017 to stretch single-use vials of the expensive asthma treatment Xolair to treat multiple patients and bill Medicare for each, driving up revenue by at least an additional $627,000, the charge said.
In addition, the practice avoided the expense of purchasing the vials from a drug maker by relying on vials that Medicaid provided for specific patients at its expense, court papers said. Prosecutors estimated the total loss at $716,418.
Prosecutors and the company’s attorney, acting with Abraham’s concurrence, agreed that the company would pay a criminal fine of $75,000.
Repayment of the ill-gotten revenue will be addressed at a future date, agency spokesman Brian McGinn said. Although still open, the business will close, the plea agreement said.
Abraham’s husband, George Abraham, incorporated the practice in 1992, records show, and was its sole doctor until he was joined in 2001 by his physician daughter Christina Abraham.
After the founder’s death in 2010, Christina Abraham continued the practice while Mary Abraham, who had medical training in her native Egypt but was not a Virginia physician, ran the office.
The criminal charge to which the company pleaded guilty attributed the fraud to Mary Abraham. A complaint from a citizen alerted authorities to the situation, McGinn said.
Government health insurance programs make Xolair, a prescription medicine, available for ongoing treatment of allergic asthma and chronic hives.
The proper dose for many patients is a portion of the single-use vial in which the drug is supplied, but insurers agree to pay for both the administered portion and the unused portion on the condition the excess is thrown away.
The single charge against the company described Mary Abraham as “a frugal person” who instead “stockpiled” the unused portions for patient use and used fraudulent billings to obtain payment from insurers.
Mary Abraham was not charged.
“It was extra medicine. I have it so I didn’t throw it away. So I used it. That’s all,” Abraham told The Roanoke Times by phone Friday. “It was an honest mistake.”
Sentencing is scheduled for Nov. 19.