How 4 doctors beat the feds in botched $500 million pill mill case

The government told jurors that Dr. Rajendra Bothra was a greedy pill pusher who ran his business like a McDonald's drive thru: pull up, get your pain meds, and go home.

Bothra's lawyer countered that wasn't the case, that Bothra was a legitimate pain specialist who helped the elderly manage unbearable aches when no one else would.

"I argued to the jury – 'You don't prosecute McDonalds for selling hamburgers. You don't prosecute KFC for selling chicken. And you shouldn't convict an interventional pain physician for doing his job and issuing prescriptions for people in pain," said defense attorney Art Weiss, whose trial strategy worked.

In a major blow to the government, a federal jury acquitted Bothra and three other doctors of all charges this week, with Bothra going home a free man, stopping first at McDonalds for his first meal out of prison in almost three years.

"He was in tears at the verdict," Weiss said of his client. "He’s still in a state of shock. He lost three and-a-half years of his life unnecessarily."

Bothra, 80, a well-connected Bloomfield Hills surgeon and philanthropist who did work with Mother Theresa, adopted a child from her orphanage and helped her build a hospital, was the lead defendant in what prosecutors called one of the largest health care scams in U.S. history.  He and five doctors who worked with him were charged with running a $500 million opioid scheme out of his three Macomb County clinics: The Pain Center USA in Warren and Eastpointe and Interventional Pain Center in Warren.

Two of the accused doctors pleaded guilty early on and testified against the others at trial, during which prosecutors sought to convince the jury that Bothra and his co-defendants were feeding America's opioid addiction to make money between 2013 and 2018.

According to the indictment, the doctors cheated Medicare and Medicaid out of nearly $500 million by illegally prescribing more than 13 million doses of prescription pain pills over five years, including OxyContin, Vicodin, hydrocodone and Percocet. Prosecutors allege the doctors got patients hooked on pain pills, and then forced them to undergo painful procedures like joint and block injections if they wanted more.

“Despite (Wednesday's)  verdicts, the United States Attorney’s Office is committed to investigating and charging medical professionals who seek to benefit financially by defrauding health care programs," U.S. Attorney Dawn Ison said in a statement. "I commend our law enforcement partners and prosecutors who worked tirelessly on this case.”

Bothra was jailed for 43 months pending the outcome of his case. He appealed nine times to be released on bond, though he lost every motion as prosecutors convinced the courts that he had hidden money and could flee to India. He almost got out on a record $7 million bond in 2019, but the prosecution appealed to the U.S. Sixth Circuit Court of Appeals, which kept him locked up,  concluding he had "the motive, means, and place to flee."

The trial lasted seven weeks, with the jury deliberating over three days before returning not-guilty verdicts. Also acquitted are:

• Dr. Ganiu Edu, 53, of Southfield

• Dr. David Lewis, 44, of Detroit

• Dr. Christopher Russo, 53, of Birmingham.

Dr. Eric Backos, 68, of Bloomfield Hills  and Dr. Ronald Kufner, 68, of Ada, pleaded guilty early on and are scheduled to be sentenced Aug. 25.

More: Michigan doctors tossed in jail for fueling opioid epidemic: They're 'killing us'

More: Opioid overdose crisis: Getting Narcan from a pharmacy is not as easy as you may think

Here is how the defense convinced the jurors to acquit:

Weiss walked the jury through the history of pain pills, explaining that most people in the 1980s could only get them if they had cancer. But then the pharmaceutical industry launched its smiley-face pain campaign, pumped up production,  and convinced doctors that the pain meds were not addictive, he said.

But as doctors prescribed more pain meds,  Weiss said, an opioid crisis emerged with with America getting hooked on pain pills. So in 2016 the Centers for Disease Control  cracked down on opioid prescriptions and the pendulum swung the other way, with primary care physicians getting tighter with writing scrips for pain meds out of fear of being investigated.

This is where Bothra came in, Weiss told the jury. He was a legitimate pain interventional specialists, and doctors and hospitals were referring their patients to him. So he took them and helped them, he said, and three national experts, including one from the University of Michigan, told jurors that this was legitimate work.

Weiss also told the jury that the injections the patients took were all legitimate and documented, and that Bothra was the only pain specialist in Michigan who had an ambulatory surgical center attached to his practice.

"This case case was not the traditional pill mill case, where you walk in there. You're a junkie.  You see a doctor for 30 seconds,  no exam, no nothing," Weiss said. "This was a fully functional and operating interventional pain management clinic. It had a credentialed surgical center, the only one in the state."

Bothra saw what Weiss described as "legacy patients" - people who had been on opiods for a considerable amount of time and had gone through therapy, massages and visited chiropractors, but nothing worked.

Weiss noted that the government used undercover operatives to investigate the clinics, recorded patient interactions with the doctors and took photos of the lobby, which, he told the jury, was full of mostly people on canes and walkers.

"They went in to try this as an ordinary pill mill case, and it wasn’t," Weiss said.  "All the records were there. Every time they did an injection – there were pictures, there were images of every procedure done."

Weiss believes he won the case because he drove this point home to the jury:

"If you have pain, you go to your primary care physician who gives you medication. When the doctor can’t make it go away," Weiss said, "you go to an interventional pain management physician who goes to the source of the pain and makes it go away."

This was Bothra, Weiss said, "and I was able to convince the jury of that."

Bothra has practiced in Warren for 30 years, during which he made a name for himself as a physician, philanthropist and political insider.  According to India Today magazine, he was appointed co-chairman of the Asian-American Coalition for the U.S. presidential election in 1988.

Bothra was also awarded the fourth highest civilian award in India, known as the Padma Shri, in 1999 and is known for his work with the poor and sick in India and his efforts to increase awareness of HIV/AIDS and drug, tobacco and alcohol addiction.

During the trial, the defense showed the jury multiple pictures of Bothra with influential figures, including Pope John Paul II and Mother Theresa.

His case was investigated by multiple agencies, including the U.S. Department of Health and Human Services, Office of Inspector General, FBI and DEA.

Tresa Baldas: tbaldas@freepress.com

This article originally appeared on Detroit Free Press: How 4 Michigan doctors beat the feds in botched $500M pill mill case