Paintsville doctor indicted on drug, fraud charges

By TONY FYFFE

BSN Editor

PIKEVILLE – A Paintsville doctor is scheduled to appear in federal court May 13 after being indicted Thursday on fraud and drug charges.

Dr. Loey Kousa is charged with unlawful distribution of controlled substances, health care fraud and false statements in connection with health care benefits.

“Kousa wrote controlled substance prescriptions for opioids, like hydrocodone and tramadol, to patients at East KY Clinic who had no legitimate need for controlled substance prescriptions in order to have continued access to these patients whose purported treatment was paid in part by health care benefit programs, including Medicare and Medicaid,” the indictment says. “Regardless of whether patients had a legitimate need for controlled substance prescriptions, as a condition of writing such prescriptions, Kousa also generally required patients to come to his clinic on a monthly, biweekly, or more frequent basis. Patients sometimes waited for hours to see Kousa but had interactions with Kousa that lasted only a few minutes and sometimes only a few seconds. These patient interactions with Kousa included minimal or no substantive medical evaluation of the patient.”

During the visits, Kousa required patients to receive unnecessary medical services, such as electrocardiograms, and billed Medicare and Medicaid for those services, the indictment says.

“Kousa tried to cover up this scheme by creating false medical records for patients to make it appear that he had performed services that would justify his prescribing and billing,” the indictment says.

The purpose of the alleged scheme was for Kousa to “unlawfully enrich himself and others” involved in managing the clinic, the indictment says.

In addition, Kousa submitted or caused the submission of claims for upcoded office visits for established and new patients “falsely representing the level of visit, duration of the visit and medical decision-making used during the visit, in order to receive higher reimbursement from the health care benefit programs than what he was entitled to receive,” according to the indictment.

Kousa also created false medical records to cover up the alleged fraudulent billing, the indictment says.

The alleged scheme occurred between Jan. 1, 2016, and February of this year, according to the indictment.

In addition, Kousa distributed and dispensed tramadol and hydrocodone without a legitimate medical purpose to a patient on five occasions in 2021, the indictment says.

The indictment also seeks the forfeiture of Kousa’s medical license, Drug Enforcement Administration registration, a money judgment in the amount of the gross proceeds obtained by Kousa as a result of the alleged violations and any property that constitutes or is derived from gross proceeds traceable to the commission of the alleged offenses.

(Editor’s note: An indictment is not the indication of guilt but a determination by a grand jury that criminal charges warrant further judicial review.)