Doctor Indicted for Orchestrating $45M Botox Fraud Scheme Targeting Medicare

A superseding indictment is a new, formal set of criminal charges in the same case that is returned by a grand jury and replaces (or supplements) the original indictment. Prosecutors use it when they want to add or drop charges or defendants, or fix problems in the first indictment. Unlike the initial indictment, which starts the case, a superseding indictment updates the charges after more investigation or legal review but does not itself decide guilt or innocence.

Medicare will only cover Botox when it is used as a medically necessary treatment for certain approved health conditions, not for cosmetic reasons like wrinkles. Examples of conditions where Botox may be covered include chronic migraine, severe muscle spasms (such as in the neck or eyelids), overactive bladder, excessive underarm sweating, some eye movement disorders (such as crossed eyes), and certain jaw (TMJ) disorders—usually after other standard treatments have been tried and failed, and when the use is consistent with FDA approval and Medicare’s medical necessity rules.

In a health‑care fraud case, “obstructing a criminal investigation” generally means intentionally interfering with investigators’ ability to get truthful information or records about possible crimes. Under 18 U.S.C. § 1518 (which covers health‑care offenses), this can include willfully preventing, delaying, or misleading investigators about records or facts—for example, falsifying or back‑dating medical records, hiding or destroying documents, or giving false information to keep agents from learning about fraudulent billing. Each such act can be charged as a separate obstruction crime.

The HHS Office of Inspector General (HHS‑OIG) is an independent watchdog office inside the Department of Health and Human Services. Its mission is to protect the integrity of HHS programs—especially Medicare and Medicaid—and the health and welfare of the people they serve. It does this by investigating suspected fraud and abuse, conducting audits and evaluations, issuing enforcement actions and recommendations, and running tools like the fraud hotline and the List of Excluded Individuals/Entities (LEIE). In cases like this Botox scheme, HHS‑OIG agents work with the FBI and Justice Department to investigate the billing fraud and support criminal prosecutions.

The Criminal Division’s Fraud Section is a specialized unit within the U.S. Department of Justice that prosecutes complex fraud cases nationwide, including health‑care fraud, securities fraud, and foreign bribery. Within it, the Health Care Fraud Unit focuses on crimes involving Medicare, Medicaid, and other health programs.

The Health Care Fraud Strike Force (often called the Medicare Fraud Strike Force) is a joint enforcement program that uses data analytics and coordinated teams of DOJ prosecutors, HHS‑OIG, FBI, and other agencies in hotspot regions to quickly identify, investigate, and prosecute health‑care fraud schemes. Since 2007, Strike Force teams have charged thousands of defendants and recovered billions of dollars for taxpayers.

After a superseding indictment is returned in federal court, the typical next steps are:

1. Arraignment on the new indictment, where the defendant appears before a judge, is informed of the updated charges, and enters a plea (usually not guilty).
2. Pretrial phase, which includes discovery (exchange of evidence), possible motions (for example, to dismiss charges or suppress evidence), and ongoing bail/detention decisions.
3. Resolution by either a plea agreement or, if no plea is reached, a trial on the charges in the superseding indictment, followed—if there is a conviction—by sentencing and potential appeals.

Medicare (through CMS) detects and helps prevent billing fraud using several tools:

• Provider enrollment screening to keep high‑risk or previously sanctioned providers out of the program.
• Data analytics and claims monitoring to spot unusual billing patterns, statistical outliers, or impossible situations (such as billing when a patient is incarcerated, the clinic is closed, or a provider appears to be in two places at once).
• Pre‑payment and post‑payment medical review and audits of questionable claims.
• Coordination with HHS‑OIG, DOJ, and the Medicare Fraud Strike Force to investigate suspects and, when appropriate, suspend payments, recover overpayments, and pursue civil or criminal cases. These measures are part of CMS’s broader “program integrity” efforts to reduce improper payments, fraud, waste, and abuse in Medicare.