IN THE MATTER OF THE SUSPENSION OR REVOCATION OF THE LICENSE OF AMGAD HESSEIN, M.D., ETC. (STATE BOARD OF MEDICAL EXAMINERS)

New Jersey Superior Court Appellate Division·Decided October 18, 2018·No. A-3308-15T3·Unpublished

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION

DOCKET NO. A-3308-15T3

IN THE MATTER OF THE SUSPENSION OR REVOCATION OF THE LICENSE OF

AMGAD HESSEIN, M.D. LICENSE NO.: 25MA067650

TO PRACTICE MEDICINE AND SURGERY IN THE STATE OF NEW JERSEY.

Argued October 9, 2018 – Decided October 18, 2018 Before Judges Sabatino, Haas and Sumners.

On appeal from the State Board of Medical Examiners, Division of Consumer Affairs, Department of Law and Public Safety.

Joseph M. Gorrell argued the cause for appellant Amgad A. Hessein (Brach Eichler, LLC, attorneys;

Joseph M. Gorrell, on the briefs).

Doreen A. Hafner, Deputy Attorney General, argued the cause for respondent State Board of Medical Examiners (Gurbir S. Grewal, Attorney General, attorney; Melissa H. Raksa, Assistant Attorney General, of counsel; Jillian G. Sauchelli, Deputy Attorney General, on the brief).

PER CURIAM Appellant Amgad Hessein, M.D., appeals from the March 28, 2016 final agency decision of the Board of Medical Examiners revoking his medical license and ordering him to pay $130,000 in penalties and $308,749.53 in costs for, among other things, fraudulent billing practices, multiple acts of gross and repeated negligence related to patient care, and the creation of false and fictitious patient records. We affirm.

I.

The Administrative Law Judge (ALJ) conducted a seventeen-day hearing, and issued a comprehensive eighty-six page initial decision. The history of this litigation and the facts relevant to this appeal are set forth at length in that decision, and in the Board's equally thorough twenty-six page final decision. Therefore, we need only summarize the most salient facts here.

Prior to the Board's revocation of his license, appellant was a Board-

certified anesthesiologist specializing in interventional pain management. Appellant was the sole practitioner in Advanced Pain Management Specialists (APMS), which had offices in Newark, Union, Roseland, Belleville, and South Orange. These offices were staffed by various personnel, including appellant's brother, Ashraf Sami, who served as the APMS office manager.

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In June 2009, Detective David Nechamkin of the Union County Prosecutor's Office initiated an investigation of appellant and his practice after receiving a complaint from a member of appellant's staff about the theft of insurance payments. The detective testified that he arranged for one of appellant's patients, J.C., to wear a recording device during her August 6, 2009 appointment with appellant. During that visit, appellant administered an injection to address J.C.'s complaints of pain only two minutes and twelve seconds after the examination began. According to appellant's own medical expert, Dr. Alexander Weingarten, appellant should have thoroughly questioned J.C., and performed a comprehensive physical examination, a process that should have taken approximately forty-five minutes, before injecting her. In addition to this breach of medical protocol, appellant prepared a fictitious progress note for J.C. indicating that the required examination had been performed. Detective Nechamkin also learned that appellant charged J.C.'s insurance company for six office visits in April 2009 even though she only visited his office twice that month.

Detective Nechamkin took statements from several other patients, including B.Z., D.C., and E.M. These patients stated they never saw appellant on consecutive days or on Sundays or Mondays when his office was closed.

A-3308-15T3

They were required to sign in when they arrived at the office, and almost always signed a consent form prior to receiving their treatment. Three other patients, J.R., T.A., and A.G. provided similar testimony at the hearing. The ALJ found the testimony by the patients who appeared at the hearing to be credible, and corroborative of the written statements provided by the other patients.

After a year-long investigation, Detective Nechamkin obtained arrest and search warrants that the prosecutor's office executed at approximately 9:00 a.m. on November 17, 2010. Detective Nechamkin arrested appellant at his home. 1 Even though appellant had yet been at work, the detective later found a stack of completed bills on the office manager's desk for interventional pain procedures that had allegedly been administered at appellant's Belleville office on that date.

1 On August 3, 2011, a Union County grand jury charged appellant in thirtyeight counts of a seventy-four count indictment with second-degree conspiracy to commit health care fraud, N.J.S.A. 2C:5-2(a)(1); second-degree theft by deception, N.J.S.A. 2C:20-4(a); and thirty-six counts of second-degree health care fraud by a practitioner, N.J.S.A. 2C:21-4.3(a). Appellant's brother was charged in the remaining thirty-six counts. On September 14, 2016, appellant pled guilty pursuant to a plea agreement to one count of second-degree theft by deception and one count of second-degree health care fraud by a practitioner. After denying appellant's motion to withdraw his plea, the judge sentenced appellant to concurrent eight-year terms on the two charges. The judge also ordered appellant to pay restitution in the amount of $235,093.75 and to forfeit $2 million. We recently affirmed appellant's conviction and sentence. State v. Hussein, Docket No. A-1693-16 (App. Div. Oct. 1, 2018).

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The ALJ found that appellant "did not perform those services on November 17" and, instead, prepared the bills "in advance of any scheduled office visits."

Two investigators assigned to the Enforcement Bureau of the Division of Consumer Affairs, Gina Galloni and Marianne Nucci, accompanied representatives of the prosecutor's office during the search of the Belleville location. While there, they observed and inventoried approximately 110 packs, bottles, vials, and sheets of expired medications in drawers, cabinets, and a refrigerator commingled with unexpired medicine. The ALJ found that their testimony on this point, which was supported by photographs of the "prodigious number" of outdated medications they discovered, was "irrefutable."

The prosecutor's office copied all of the patient records seized from appellant and gave them to Galloni and Nucci. Galloni reviewed appellant's billing and treatment records for a representative sample of six patients, D.C., B.Z., A.G., J.R., T.A., and J.C. She looked to see if the patients, Medicare, Medicaid, or a private insurance provider had been billed for services where the patient's name did not appear in the scheduler maintained by appellant and his office staff, on consecutive dates, on Sundays or Mondays when the offices were closed, or where the patient had not signed the required consent form. Out of 348 total visits recorded by appellant for these six patients, Galloni found that

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175 of those visits were billed when the patient was not on the schedule. Another twenty-eight visits allegedly occurred when the office was closed, and eighty-two more were on consecutive days, which the patients stated did not occur.

After hearing and observing Galloni as she testified, the ALJ concluded that the investigator's "detailed recitation of the methodology she used to review, compare, and organize the data presented to her, reflect[ed] a professional, methodical, thorough[,] and credible process." The ALJ also found that appellant failed to present any "persuasive arguments to question the accuracy of the data assembled by Galloni from patient records, patients statements," and information she received from appellant's billing company.

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IN THE MATTER OF THE SUSPENSION OR REVOCATION OF THE LICENSE OF AMGAD HESSEIN, M.D., ETC. (STATE BOARD OF MEDICAL EXAMINERS), (N.J. Ct. App. 2018).

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