Paintsville doctor pleads not guilty; July trial date scheduled

By TONY FYFFE

BSN Editor

PIKEVILLE — A July 13 trial date was set for a Paintsville doctor after he pleaded not guilty Monday to federal drug and fraud charges.

During his arraignment Monday in U.S. District Court at Pikeville, a magistrate judge also prohibited Dr. Loey Kousa from prescribing controlled substances and traveling out of the country while on release.

Kousa was indicted April 28 on federal charges of unlawful distribution of controlled substances, health care fraud and false statements in connection with health care benefits.

The indictment says 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.”

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.

Assistant U.S. Attorney Dermot Lynch filed a motion May 3 asking to prohibit Kousa from prescribing controlled substances as a condition of his pretrial release.

The motion said that evidence establishes that Kousa “illegally prescribed controlled substances to an undercover agent, who posed as an EKC patient and Medicare beneficiary, recorded his interactions with Defendant, and was able to get opioid prescriptions from Defendant based on little more than vague complaints of shoulder pain during office visits that lasted minutes or sometimes seconds.”

Kousa’s attorney disputed those claims, saying the doctor ordered “multiple external laboratory tests” for the undercover agent and denied requests for controlled substances until he received the test results.

The attorney, Ronald W. Chapman II, also said in his court filing that the state of Kentucky on Saturday suspended Kousa’s ability to prescribe controlled substances, but not his ability to practice medicine.