St. Louis Area Doctors Accused of Illegally Administering Ketamine
ST. LOUIS – Two doctors from the St. Louis area were indicted Wednesday and accused of illegally administering ketamine to patients and fraudulently billing Medicare for certain services related to a psychiatric clinic.
Dr. Asim Muhammad Ali, 53, and Dr. Mohd Azfar Malik, 70, were each indicted on 22 felony counts: conspiracy to illegally distribute controlled substances and to maintain a drug-involved premises, conspiracy to commit health care fraud, 12 counts of illegal distribution of a controlled substance, seven counts of making false statements related to health care matters and one count of maintaining a drug-involved premises.
The indictment says Dr. Ali, an internal medical specialist, defrauded Medicare when he falsely used Dr. Malik’s name and Medicare billing number to bill for health care services, including annual wellness visits. The indictment also says Dr. Ali illegally administered intravenous ketamine and a nasal spray version of the drug without authorization.
Among businesses owned by Dr. Malik, a psychiatrist, was COPE Ketamine Clinic in south St. Louis County, the indictment says. COPE was created to provide intravenous ketamine infusions for serious mental health illnesses, such as treatment-resistant depression, anxiety disorders and post-traumatic stress disorder.
Dr. Malik had a Drug Enforcement Administration registration authorizing him to administer controlled substances, but not at the office suite housing COPE, the indictment says. He was also enrolled in the Spravato Risk Evaluation and Mitigation Strategy Program (REMS), which authorized him to administer the prescription esketamine nasal spray Spravato. Spravato is used to treat treatment-resistant depression and depressive symptoms in adults with major depressive disorder with suicidal thoughts or actions. Due to the risks of the drug, Spravato is only available through REMS and must be administered under the direct supervision of a healthcare provider who is onsite for at least two hours to monitor patients.
Dr. Ali did not have a DEA registration and thus was not authorized to administer ketamine unless he was being directly supervised by and in the physical presence of a practitioner with a DEA registration, and only if the ketamine was being administered in a DEA-registered location, the indictment says.
Dr. Ali was also suspended from participation in the Missouri Medicaid program in December 2020 and had a duty to report that to Medicare, it says. The indictment says he failed to do so and failed to fulfill his obligation to inform Medicare that he was providing services to Medicare beneficiaries through Dr. Malik's businesses.
The indictment alleges that beginning in December 2020, Dr. Malik and Dr. Ali agreed that Dr. Ali would use Dr. Malik's DEA registration to administer ketamine infusions to patients without direct supervision by Dr. Malik and outside of Dr. Malik's physical presence. Dr. Malik knew that Dr. Ali could not lawfully dispense controlled substances, including ketamine, without Dr. Malik's physical presence and supervision, it says. Dr. Ali and Dr. Malik also determined that Dr. Malik could simply "say hi" to the ketamine patients, typically via telephone, as a purported justification for Dr. Ali handling their ketamine treatment, the indictment says.
The indictment also alleges that Dr. Malik and Dr. Ali unlawfully stored ketamine and esketamine at COPE.
"The Drug Enforcement Administration’s Diversion Program is dedicated to patient safety and oversight of all medical professionals registered with DEA,” said Diversion Program Manager Kim Daniels, DEA’s lead for the Diversion program in Missouri, Kansas and southern Illinois. “With the support of our enforcement partners, DEA will investigate to the maximum extent of our ability to ensure these individuals are prevented from risking lives within our communities.”
The conspiracy charges each carry the possibility of a penalty of up to 10 years in prison and a fine. The illegal distribution of a controlled substance charge carries a penalty of up to 10 years in prison, a fine of $500,000 or both. The false statements charge carries a penalty of up to five years in prison, a fine of $250,000 or both. The charge of maintaining a drug-involved premises carries a penalty of up to 20 years in prison and/or a $500,000 fine.
Charges set forth in an indictment are merely accusations and do not constitute proof of guilt. Every defendant is presumed to be innocent unless and until proven guilty.
DEA investigated this case with the FBI and the U.S. Department of Health and Human Services Office of Inspector General and the Missouri Medicaid Fraud Control Unit.