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• 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

• 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

• 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

• 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

Barry.carrier@tn.gov