Barbara Neyhart Full Testimony

Case 2:08-cr-00427-MCE Document 440
Filed 07/06/11 Page 1 of 48
IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA
---oOo--BEFORE THE HONORABLE MORRISON C. ENGLAND, JR., JUDGE
---oOo--UNITED STATES OF AMERICA,
Plaintiff,
vs.
No. 2:08-cr-00427
ALEXANDER POPOV,
RAMANATHAN PRAKASH, LANA
LE CHABRIER,
Defendants.
---oOo--REPORTER'S PARTIAL TRANSCRIPT

CROSS-EXAMINATION OF BARBARA NEYHART, M.D.
MONDAY, JUNE 27, 2011
---oOo---
Reported by:
DIANE J. SHEPARD, CSR #6331, RPR
DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

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APPEARANCES
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For the Government:

BENJAMIN B. WAGNER
UNITED STATES ATTORNEY
501 I Street, Suite 10-100
Sacramento, California 95814
BY: PHILIP A. FERRARI
JEAN M. HOBLER
Assistant U.S. Attorneys
For the Defendant, Lana Le Chabrier

JAN DAVID KAROWSKY
Attorney at Law
716 19th Street, Suite 100
Sacramento, California 95811
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For the Defendant, Alexander Popov:

RICHARD ALAN MOSS
Attorney at Law
255 South Marengo Avenue
Pasadena, California 91101
For the Defendant, Ramanathan Prakash:

RONALD NEIL RICHARDS
Attorney at Law
P.O. Box 11480
Beverly Hills, California 90213
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SACRAMENTO, CALIFORNIA
MONDAY, JUNE 27, 2011
PARTIAL TRANSCRIPT
---oOo---
BARBARA NEYHART, M.D.,
a witness called by th1e Government, having been first duly
sworn by the Clerk to tell the truth, the whole truth, and
nothing but the truth, testified as follows:
CROSS-EXAMINATION
10
BY MR. RICHARDS:
11
Q.
12
fraudulent billing files to Medicare, have you?
13
A.
No.
14
Q.
And the second set of charts that you have in front
15
of you, on the addendum that you wrote your report on, those
16
weren't randomly selected, were they?
17
A.
18
me to be an expert in this case.
19
Q.
Phil Ferrari, right?
20
A.
Correct.
21
Q.
Would you be surprised to know the second set of
22
charts were the second substantive counts that my client
23
Dr. Prakash was charged with?
24
A.
I have no opinion.
25
Q.
Did you ever know how many charts there were, total,
Dr. Neyhart, you've never worked on detecting
They were provided to me by the attorney who called
I'm sorry, sir.
in all the charts that the Government has?
that question?
A.
me last Wednesday.
Q.
ask if those charts were cherry-picked for you?
A.
No.
Q.
So did you ever ask the Government if you can go
through the other 1940 charts and see if there was any
10
Did you ever ask
I never asked, but that information was provided to
And the original CD that you were sent, did you ever
similarities?
11
MR. FERRARI:
12
THE COURT:
Objection.
Misstates the record.
Sustained.
13
Q.
BY MR. RICHARDS:
How many charts are over there, do
14
you know?
15
A.
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seized.
17
Q.
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ask the Government if you could just look through the charts on
19
your own rather than them giving you a CD with the charts they
20
want you to look at?
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A.
No.
22
Q.
Now isn't it true you've never done any research on
23
what a doctor should look for to spot files that have been
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fraudulently created for Medicare submissions?
25
A.
I was told that there were about 500 charts that were
And out of 500 charts that were seized, did you ever
I had no occasion to do so.
That is correct.
Q.
And isn't it true that elderly people have more organ
failures than younger people?
A.
Yes, that is correct.
Q.
And you told the jury that you're someone that looks
at doctors' work for the Medical Board, correct?
A.
Correct.
Q.
And I listened very carefully during that testimony,
and you said "I listen to interviews of the doctor," correct?
A.
Correct.
10
Q.
And when you review a doctor's work, it would be
11
great to interview the doctor, wouldn't it?
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A.
13
I'm provided with an interview that was conducted by another
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physician.
15
Q.
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skills.
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that it's very helpful to listen to what the doctor's
18
explanations are for the things they did or did not do,
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correct?
20
A.
It's helpful but not critical.
21
Q.
Out of all the doctors that you've evaluated, how
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many would you say you never hear any interviews of why the
23
doctor did what they did?
24
A.
About half of them.
25
Q.
And when you were -- when you were -- but would it be
There are times in my work for the Medical Board that
I personally never interview the doctors.

But I'm trying to establish for your diagnostic
So when reviewing another doctor's work, isn't it true
fair to say if you had your preference, that you would want the
doctor interviewed?
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4
Come on, don't you want to know why they did what
they did?
MR. FERRARI:
THE COURT:
Objection.
Sustained.
Q.
in a file -- let me strike that.
Argumentative.
BY MR. RICHARDS:
Don't answer the question.
If you were unsure about something
Let's just pretend you're at U.C. Davis, and you look
10
at some work another doctor did, and you don't understand it.
11
Has that ever happened before?
12
A.
It happens all the time.
13
Q.
And isn't the fastest way to resolve your concern to
14
pick up the phone and call the doctor?
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A.
I wish it was.
16
Q.
But wouldn't that be the easiest way?
17
A.
That would be the most desirable way, yes.
18
Q.
But in order to understand why a doctor did or didn't
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do something, the best way would be to call the doctor, if that
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was an option, correct?
21
A.
If that was an option.
22
Q.
And in this case are you aware that patients were
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paid $100 a patient to go to the clinics?
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MR. FERRARI:
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THE COURT:
Objection.
Relevance.
Sustained.

BY MR. RICHARDS:
Q.
charts, did you assume that the patients were fabricating their
results?
A.
No.
Q.
And isn't it true if the patient has a financial
interest in getting treatment, that could skew a lot of your
findings?
MR. FERRARI:
THE COURT:
When you were evaluating these
Objection.
Foundation.
Sustained.
10
Q.
BY MR. RICHARDS:
Isn't it true that if a patient is
11
holding back facts to the clinician, that could affect the
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clinician's diagnosis?
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MR. FERRARI:
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THE COURT:
Objection.
Foundation.
Sustained.
15
Q.
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find out what's wrong with them?
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A.
The presumption is that the patient is suffering.
18
Q.
But if the patient is lying or just trying to get
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through the exam, that could affect your observations, correct?
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A.
It could influence my conclusions, yes.
21
Q.
Would it be fair or unfair to say that patients that
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are getting paid to go to a clinic may present themselves
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differently than patients that are going without some sort of
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financial benefit?
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BY MR. RICHARDS:
MR. FERRARI:
Why do you talk to a patient to
Objection.
Foundation and relevance.

1
THE COURT:
Sustained.
Q.
BY MR. RICHARDS:
Isn't it true when you're examining
patients, you don't pay them to come to your clinic, correct?
A.
That is correct.
Q.
All right.
questionnaire as to who the patient's primary physician is, do
you?
A.
medical problems or a current physician.
And in these charts you don't see any
I see nothing to indicate that they have either prior
10
Q.
But there's nothing in the chart that even has a
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space for a primary care physician, correct?
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A.
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corresponding to primary care physician.
14
Q.
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patients, correct?
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A.
I have no way of knowing.
17
Q.
And if a patient was just showing up to go through
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the motions, they may have not cared whether the clinic knew
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about their primary care physician, correct?
There is no printed document with a blank
So you don't know if that was even asked of these
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MR. FERRARI:
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THE COURT:
Objection.
Foundation.
Relevance.
Sustained.
22
Q.
BY MR. RICHARDS:
Now, you said you've worked a lot
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with patients from Southeast Asia?
24
A.
Correct.
25
Q.
And isn't it true that a lot of these patients take
herbal medication?
A.
Some do, but not all.
Q.
Well, I notice that -- you do know most of these
patients were old, right?
A.
65.
Q.
prior medications weren't put in the exam -- put in the initial
evaluation, right?
I know that these patients were all over the age of
And you sort of commented on the fact that their
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A.
In all patients except for one there were no
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currently used medications listed.
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Q.
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people that were common of the charts that you viewed, don't
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remember all their medications constantly?
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A.
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medications is two very different things.
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Q.
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culturally are very secretive?
And isn't it true that elderly people, especially
Not remembering and denying that they are taking
Well, isn't it true that these type of patients
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MR. FERRARI:
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THE COURT:
Objection.
Foundation.
Sustained.
21
Q.
BY MR. RICHARDS:
When these patients came to the
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clinic, you noticed that every single one did not want a pelvic
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or rectal exam, right?
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A.
I noticed that that's what was documented.
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Q.
Do you know if that's true at all?
Filed 07/06/11 Page 10 of 48
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A.
Of these particular patients?
Q.
Yeah.
A.
I have no way to know one way or the other.
Q.
Do you even know when the clinic on Folsom closed?
A.
I didn't even know the clinic on Folsom existed until
I was asked to review this case.
Q.
visit.
have an impact on why you didn't see a return visit?
But you made an opinion that you didn't see a return

So if the clinic closed a week later, wouldn't that
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A.
It certainly would.
But I never reviewed the charts
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to ferret that out.
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Q.
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Teitelbaum.
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A.
No, I haven't.
15
Q.
So prior to today, you never once asked Mr. Ferrari
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who is this Sol M.D., I need to look him up?
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A.
No.
18
Q.
So you don't think it's important to know what
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clinician is initially evaluating the patient when you're
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reviewing another doctor's choices?
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A.
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whether or not the standard of care was met.
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to ascribe who was the provider of the care.
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Q.
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whether a doctor is doing the initial evaluation of a patient
That was not my charge.
You saw my colleague's questions about Sol

You've heard that name, right?
I was only asked to review the charts in terms of

I was not asked
Well, isn't it true that it makes a big difference

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Filed 07/06/11 Page 11 of 48
or a nurse?
MR. FERRARI:
THE COURT:
Objection.
Vague.
Sustained.
Q.
BY MR. RICHARDS:
of those charts, signed by -- let's just say, hypothetically,
for these questions that was Sol Teitelbaum, a licensed
physician -- does that make a difference with respect to who is
doing the initial evaluation with respect to how you're going
to handle it?
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MR. FERRARI:
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THE COURT:
When you saw the M.D. line on each
Objection.
Vague.
Sustained.
12
Q.
BY MR. RICHARDS:
13
Dr. Prakash never -- that in this case Dr. Prakash looked at
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Sol Teitelbaum's observations when reviewing those files?
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you aware of that?
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MR. FERRARI:
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THE COURT:
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Q.
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In this case, are you aware that
Objection.
Are
Foundation.
Sustained.
BY MR. RICHARDS:
Just as a yes or no.
Are you a --
In this case, do you know what Dr. Prakash's role is
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with respect to the evaluation of these charts?
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A.
No.
22
Q.
All right.
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assess whether a doctor, whose job was to determine the quality
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control, could make those evaluation -- what they should look
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for when they were reviewing another doctor's observations?
So isn't it true you were never asked to

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MR. FERRARI:
THE COURT:
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Filed 07/06/11 Page 12 of 48
Objection.
Foundation.
Sustained.
Q.
BY MR. RICHARDS:
Do you know this is not a medical
malpractice trial?
A.
Yes.
Q.
You know it's a criminal trial, right?
A.
Yes.
Q.
And you know that my client's not being charged with
violating the standards of care, that's not the charge in this
10
case?
11
A.
Yes.
12
Q.
Did you ever ask the Government, "why am I evaluating
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the standard of care when this is a case about fraud?"
14
A.
I was not told that it was a case about fraud.
15
Q.
I saw the e-mails Mr. Ferrari sent you.
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case title was USA versus Popov, Prakash and Le Chabrier.
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on the e-mails, right?
18
A.
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that other name.
20
Q.
Well, you knew it was a criminal trial, didn't you?
21
A.
Yes.
22
Q.
Now, you indicated that you wouldn't -- you
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personally would not sign a chart unless you understood all the
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writings in the chart, remember that?
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A.
I saw Popov, and I saw Prakash.
You saw the

It's
But I don't recall
I'm sorry.
I don't remember the specific words, but that is
Filed 07/06/11 Page 13 of 48
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generally my policy.
Q.
aren't allowed to sign just your name anymore, you actually
have to write out some more information, correct?
A.
Correct.
Q.
And you're not suggesting that in 2006 that somehow
there was something inappropriate about a doctor simply signing
a chart rather than what is now the new U.C. Davis policy of
writing out a lengthy explanation?
And you said that recently at U.C. Davis you actually
10
A.
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about a decade.
12
Q.
A decade.
13
A.
At least.
14
Q.
So are you suggesting that any doctor that simply
15
signs a chart is doing something wrong?
16
A.
No.
17
Q.
So isn't it fair to say that all over California
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doctors sign charts without any explanation?
19
A.
Yes.
20
Q.
And if we could pull up on the screen Exhibit 175 --
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172-25, please.
22
23
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I'm sorry.
All right.
73-year-old male.
The new U.C. Davis policy dates back
So it goes back to 2001?
This is a patient that on this page was a
And if we could then go to 172-27.
All right.
Now you testified when you first saw this
that you can't tell who this is by this page, right?

1
MR. FERRARI:
THE COURT:
THE WITNESS:
Q.
Filed 07/06/11 Page 14 of 48
Objection.
14
Overruled.
Vague.
Let her answer the question.
I'm sorry?
BY MR. RICHARDS:
Let me withdraw the question.
You couldn't -- when you first testified about this,
you said, oh, I can't tell if this is a male or a female,
remember that?
A.
there is no specificity as to sex and the genital examination.
10
Q.
11
I cannot tell by the name, and I cannot tell because
All right.
If we can just enlarge this, please.
All right.
You know that's BPH, right?
12
A.
Ah, there we go.
13
Q.
Benign prostatic hyperplasia, correct?
14
A.
Benign prostatic hypertrophy.
15
Q.
Is that possible to be on a woman, or does it have to
16
be a man?
17
A.
That has to be a man.
18
Q.
All right.
19
If we can go back to the large page.
And also you don't only look at one page in a chart,
20
you look at the entire chart, right?
21
A.
22
single detail on every single page.
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been flashed back and forth before me, I have not been able to
24
ferret out every single detail.
25
Q.
I look at the entire chart, and I look at every

But as these screens have
When you testified earlier, you said you couldn't
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Filed 07/06/11 Page 15 of 48
tell if this was a male.
Now that I pointed it out to you, you
can tell, right?
A.
front of my face, yes.
Q.
had trouble determining whether it was a female or male
patient, correct?
A.
No.
Q.
Because they had IDs and some pages did say F and M,
Now that it's not being flickered back and forth in
But there was no chart that you looked at that you
10
right?
11
A.
Correct.
12
Q.
And if we could just enlarge this, please.
13
This arrow right here, that means this part should be over
14
here, correct?
15
A.
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bracket.
17
Q.
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exam, right?
19
A.
20
that the patient refused the area of investigation that is
21
bracketed.
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bimanual, a gynecologic examination.
23
Q.
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25
No.
I don't see that as an arrow.
Okay.
I see that as a
So this means that the patient refused the rectal
That's what is documented.
What is documented is
In this case, what is bracketed is pelvic and
We can remove that, please.

Now you're not aware of how many other charts
Dr. Prakash was reviewing in Los Angeles during 2006, are you?

1
A.
is the first to me.
Q.
Did you know Dr. Prakash was a neurologist?
A.
No.
Q.
No?
next area.
complaints are?
Now I know that Dr. Prakash was in Los Angeles.
Well, that's good.
This
I'll move right on to my
Do you know what 99 percent of neurologist's chief
MR. FERRARI:
THE COURT:
10
16
Filed 07/06/11 Page 16 of 48
Objection.
Foundation.
Overruled.
THE WITNESS:
I'm sorry.
Dr. Prakash is -- his
11
specialty again?
12
Q.
BY MR. RICHARDS:
13
A.
Nerves.
14
statement "urology."
15
Q.
No.
16
A.
Nerves.
17
Q.
Unless I am pronouncing something wrong.
18
neurologist.
19
A.
20
when you did a follow-up question you said urologist, which is
21
another part of the human body.
22
Q.
23
be sitting next to him.
24
25
Neurology?
Neurology.
I thought you said in your next
He's a neurologist.
Did you say nerves?
Are we talking about neurology?

He's a
Isn't that the head?
Head.
Head, nerve, brains.
I'm sorry.
I thought
Yeah, he's definitely not a urologist, or I wouldn't
As far as neurology is concerned, do you know what a

-- isn't it true that a neurologist -- you never evaluated
Filed 07/06/11 Page 17 of 48
neurologists for the California Medical Board, correct?
A.
No.
Q.
And that's because you're not a neurologist?
A.
Correct.
Q.
And do you know that 99 percent of a neurologist's
chief complaints are dizziness and headaches?
A.
99 percent seems to be a pretty high number to me.
Q.
Do you know what a migraine is?
A.
I certainly do.
10
Q.
That's a very common head ailment, right?
11
A.
That's one of many neurologic conditions, yes.
12
Q.
But, if you know, when a neurologist sees headache,
13
dizzy, do you know whether or not that's going to jump out at
14
him as something is wrong in Kansas?
17
That would not be permitted.
15
MR. FERRARI:
16
THE COURT:
Objection.
Vague.
Sustained.
17
Q.
BY MR. RICHARDS:
So when you reviewed these entire
18
files, would it be fair or unfair to say that you're not really
19
qualified to evaluate what a neurologist should know when he's
20
reviewing these files?
21
A.
22
Whether or not a neurologist was reviewing general medical
23
care, the care was general medical care.
24
generalist, I feel as though I am in a position to review
25
general medical care.
The care that was provided was general medical care.
Thus, as a
Filed 07/06/11 Page 18 of 48
18
Q.
But a lot of times people are referred to
specialists, isn't that correct?
A.
That is correct.
Q.
And these were tests that were done -- the referrals
were done after they were reviewed under their general care,
isn't that correct?
A.
time as the initial evaluations was made.
Q.
I believe that the referrals were made at the same
But do you know how many neurologists prescribe
10
transcranial dopplers?
11
A.
12
at U.C. Davis for over 25 years, and I have reviewed many, many
13
charts, and received many referral letters from neurologists,
14
and at no time have I seen that a transcranial doppler has been
15
ordered.
16
Q.
17
saying that that should be a siren, you should call the police
18
if you see one, right?
19
MR. FERRARI:
20
THE COURT:
I cannot give you a number.
I can say that I've been
So if a transcranial doppler's been ordered, you're
Objection.
Argumentative.
Sustained.
21
Q.
BY MR. RICHARDS:
22
aware that Medicare paid out transcranial doppler after
23
transcranial doppler?
24
MR. FERRARI:
25
THE COURT:
In this particular case, are you
Objection.
Overruled.

1
THE WITNESS:
I'm not aware that Medicare determines
the standard of care.
Q.
physician made observations and recommended a transcranial
doppler dozens and dozens of times?
BY MR. RICHARDS:
MR. FERRARI:
THE COURT:
Are you aware that another licensed
Objection.
Vague and foundation.
Sustained.
Q.
you saw a physician at U.C. Davis recommend a transcranial
10
19
Filed 07/06/11 Page 19 of 48
BY MR. RICHARDS:
That's a different question.
If
doppler, would you call the police?
11
MR. FERRARI:
12
THE COURT:
Objection.
Vague and argumentative.
Sustained.
13
Q.
BY MR. RICHARDS:
14
transcranial doppler so out of whack that you would do -- you
15
would report it to law enforcement?
16
MR. FERRARI:
17
THE COURT:
Is the recommendation of a
Objection.
Vague.
Sustained.
18
Q.
BY MR. RICHARDS:
Do you disagree with what Harrison
19
says, that it's a good diagnostic tool for specific lesions?
20
A.
21
this court trial --
22
Q.
23
just so --
I'm going to go back on what I have said throughout
This is a jury trial, Dr. Neyhart.
24
MR. FERRARI:
25
THE COURT:
Objection.
That's the jury,
Argumentative.
Counsel, stop.

1
THE WITNESS:
THE COURT:
20
Filed 07/06/11 Page 20 of 48
Thank you for the clarification.

Please stop.
Slow down and stop the
argumentative examination.
THE WITNESS:
There is no reason to order a test
unless it is going to have an impact on patient care.
of these patients did I discern that there were -- was a
suspicion that a vascular abnormality would be uncovered that
would lead to a change in patient care management.
includes the performance of the transcranial doppler.
10
Q.
BY MR. RICHARDS:
11
were suffering from dementia?
12
MR. FERRARI:
13
THE COURT:
In none
That
Do you know a lot of these patients
Objection.
Foundation.
Sustained.
14
Q.
BY MR. RICHARDS:
15
see some of these patients were suffering from symptoms that
16
are consistent with memory recollection (sic)?
17
A.
18
these patients were cognitively impaired.
19
Q.
Do you know what e-r-r stands for?
20
A.
Can you help me?
21
Q.
Well, if there's a language barrier like in this
22
case, isn't it better to e-r-r on the side of more tests?
23
A.
Oh, "err."
24
Q.
Err, yes, e-r-r?
25
A.
Err as in -- sorry, I thought it was an acronym.
No.
When you read the files, did you
There was nothing in the record to suggest that

1
Q.
Reader's Digest last night.
E-r-r.
Filed 07/06/11 Page 21 of 48
21
I was using the medical acronym that I read in

I'm kidding.
Isn't it true that if there's a language
barrier, it's better to e-r-r on the side of more tests?
A.
No.
Q.
No.
A.
What's appropriate is to -- is to ask for an
interpreter so that the history is accurate.
Q.
Well, can you point to a specific file that
10
Dr. Prakash looked at on his set of files, after seeing
11
Dr. Teitelbaum's observations, and he should have known right
12
away that there's something wrong with Dr. Teitelbaum's
13
observation?
14
MR. FERRARI:
15
THE COURT:
Objection.
Foundation.
Sustained.
16
Q.
BY MR. RICHARDS:
17
Teitelbaum on them under the physician M.D. section, assume
18
he's a doctor, is there one file that you can point to that
19
when reviewing Dr. Teitelbaum's observations, it should be
20
immediately apparent that those observations were fictitious?
21
MR. FERRARI:
22
THE COURT:
Assume all the files that say Sol
Objection.
Foundation.
Sustained.
23
Q.
BY MR. RICHARDS:
When you were reviewing these
24
files, did you assume that another doctor looked at the files
25
first before Dr. Prakash?
Filed 07/06/11 Page 22 of 48
22
A.
No.
Q.
So you didn't know whether Dr. Prakash looked at the
files first or Dr. Teitelbaum, correct?
A.
attention today, ergo, when I was reviewing the charts, I had
no idea that Dr. Teitelbaum was involved in the care of these
patients.
Q.
that if someone that wasn't a doctor, wasn't a nurse, just a
The existence of Dr. Teitelbaum was brought to my
Well, isn't it true it could affect your analysis
10
lay person made these observations versus a doctor, doesn't
11
that have on impact?
12
A.
13
necessarily -- it isn't the final word on credibility.
14
Q.
15
"Doctor" gives an air of credibility, but it does not
Just -- let me strike that.

If you were reviewing another doctor's file at Davis,
16
and you knew it was a legitimate doctor, like a licensed
17
doctor, you would handle a call to that doctor differently
18
than, let's say, if I reviewed it?
19
MR. FERRARI:
20
THE COURT:
Objection.
Vague.
Sustained.
21
Q.
22
as maybe -- as how long you're going to look at the file if
23
it's another doctor's personal observations versus just an
24
office person that is not a physician?
25
BY MR. RICHARDS:
MR. FERRARI:
Doesn't it make a difference as far
Objection.
Vague.

1
THE COURT:
23
Filed 07/06/11 Page 23 of 48
Sustained.
Q.
BY MR. RICHARDS:
Dr. Prakash's patients have headaches, dizziness, and blurry
vision, that fits almost all of the type of patients he sees?
MR. FERRARI:
THE COURT:
Are you aware that all of
Objection.
Foundation.
Sustained.
Q.
BY MR. RICHARDS:
You were critical in your report
that there was vitamin studies -- or vitamin test done.
remember that?
Do you
10
A.
I recall being concerned about the folate test and
11
the serum iron test.
12
Q.
13
above 65 if you don't isolate their vitamin levels, do you
14
know?
15
A.
16
-- for none of these patients was the chief complaint or the
17
expanded chief complaint dementia or a memory disorder problem.
18
So I don't really understand this line of inquiry.
19
Q.
20
their B-12 levels are in their blood to determine to see if
21
they're suffering from any low levels?
How do you diagnosis cases of dementia for people
Yes, actually, I do know.
But none of these patients
Well, because if -- don't you have to look at what
22
MR. FERRARI:
23
THE COURT:
Objection.
Vague.
Sustained.
24
Q.
BY MR. RICHARDS:
Isn't it important to know what
25
their iron B-12 is in their blood?

1
MR. FERRARI:
THE COURT:
24
Filed 07/06/11 Page 24 of 48
Objection.
Vague.
Sustained.
Q.
BY MR. RICHARDS:
With respect to dementia.
Do you
know?
A.
these patients were purportedly suffering of dementia.
part of the dementia work-up is ordering the serum B-12 level.
It is not ordering the iron level.
Q.
We're speaking very hypothetically because none of

But
So you're saying that ordering the iron B-12 is not
10
something you would do as a family practitioner, correct?
11
A.
No.
12
Q.
What about as a neurologist?
13
would do?
14
A.
I --
15
Q.
No, you don't.
16
MR. FERRARI:
17
THE COURT:
Objection.
Do you know what they
Vague.
Argumentative.
Sustained.
18
Q.
BY MR. RICHARDS:
Do you remember the patient Savoeun
19
Prum?
20
A.
21
has in front of them, which is just a listing of the patients.
22
Q.
Didn't Mr. Moss give you your addendum there?
23
A.
Am I allowed to look at what he provided to me?
24
Q.
I want you -- you can look at it.
25
about it.
Can you go to the report you have in front of you?

I have the same thing in front of me that the jury
Just don't talk
I just wanted to go to that page on your report.
Filed 07/06/11 Page 25 of 48
25
A.
The page?
Q.
It would be problems re medical records of Savoeun
Prum.
and then count back four pages.
A.
Yes, I'm there.
Q.
Okay.
evaluate the chief pain complaint.
criticism?
A.
Not chief pain.
10
Q.
Chest pain.
11
chest pain.
12
A.
Yes.
13
Q.
But isn't it true that the EKG done in that file was
14
normal?
15
A.
16
or rule out angina.
17
Q.
18
that they didn't do enough tests, right, is that fair to say?
19
A.
It's fair to say they did not do the right tests.
20
Q.
So an EKG was the wrong test, is that your opinion?
21
A.
That was one test that was right.
22
Q.
Well, when you go to the -- when you go to a clinic
23
for the first time, isn't it true you don't immediately put
24
someone on a stress test?
25
I'm sorry, sir, which page?
It's the fourth page from the back.
Just go to the end
You said that there was no stress test done to

Do you remember that
Chest pain.
There was no stress test to evaluate the
Do you remember that?
Resting EKG is not sufficient information to rule in
But when someone -- in this case you were critical
MR. FERRARI:
Objection.

1
2
THE WITNESS:
Filed 07/06/11 Page 26 of 48
26
You don't immediately do that nor do
you immediately order a transcranial ultrasound.
But if they complain of chest pain, you're darn
tootin' that you're going to want to have them stress tested to
make sure that they aren't going to have a heart attack.
Q.
evaluation.
8
9
BY MR. RICHARDS:
Let's focus on the initial
Let me just give you a hypothetical.
Dr. Prakash gets the file, and he sees that the EKG
is normal, and the patient only went there once.
Is there
10
something that should just stick out at the time, when he sees
11
a normal EKG, that he should have called and said, why didn't
12
we do a stress test, is that what your opinion is?
13
A.
14
had chest pain and was in a high-risk category for heart
15
disease, that he would have -- had he thoroughly reviewed the
16
chart -- would have requested further testing or further
17
evaluation.
18
Q.
Well, did you see the PFT?
19
A.
I did.
20
Q.
And isn't it true that it showed a severe
21
neurological disease?
22
A.
23
No.
My opinion is that when he saw that the patient
Why don't you take a look at it.
(Witness reviewing document.)

I'm sorry.
In this conclusion section I don't seem
24
to have the pulmonary function test transcribed.
25
Q.
Well, so you don't remember whether it showed severe
Filed 07/06/11 Page 27 of 48
neurological disease?
A.
don't recall with respect to this patient what the pulmonary
function test showed.
Q.
You saw these tests by Dr. Heric.
A.
Yes.
Q.
And you have no idea whether these tests are
legitimate or not, correct?
27
Having reviewed 40 separate medical records, no, I
All right.
10
MR. FERRARI:
11
THE COURT:
If we could pull up 177, page 17, please.
Objection.
Do you see that?
Vague.
Sustained.
12
Q.
BY MR. RICHARDS:
You don't know if this test was
13
ever actually done, do you?
14
A.
15
reviewed this for my report.
16
Q.
17
is putting fake tests in a file, that you can't make any
18
correct evaluation of the diagnosis, correct?
I always assumed it was done as written when I
But is it fair or unfair to say that if a fraudster
19
MR. FERRARI:
20
THE COURT:
Objection.
Foundation.
Sustained.
21
Q.
BY MR. RICHARDS:
If I told you this test was
22
fictitious, meaning it was just put in the file by somebody
23
that was bilking Medicare, would that change your opinion on
24
the care as to this patient?
25
A.
It would --

1
Q.
do this.
28
Filed 07/06/11 Page 28 of 48
I'm going to withdraw that.
I have an easier way to
You were critical that some of these results came
back, and you didn't see any evidence that the patient was
called.
A.
Yes, I do.
Q.
That assumes, doesn't it, that Dr. Prakash knew that
test result was even in the file, right?
A.
Do you remember that testimony?
That presumes that Dr. Prakash reviewed that result
10
in the context of that patient's entire file, yes.
11
Q.
12
another criticism was, you know, on some of these charts
13
there's no evidence that the doctor actually reviewed the test
14
results, right?
15
And you don't see on here something that says that --
"Interpretation" was the word used.
I'm trying to speak in English for the jury.
16
doctor didn't review some of these results, right?
17
A.
18
others.
19
Q.
20
no reason for the doctor to review it, right?
The
Not the one that's on the screen right now, but
But if the result was a fake result, there would be
21
MR. FERRARI:
22
THE COURT:
Objection.
Foundation.
Sustained.
23
Q.
BY MR. RICHARDS:
As you truthfully testified, you've
24
never tried to make diagnoses in the past with charts that have
25
counterfeit or fake test results in there, have you?

1
2
MR. FERRARI:
Filed 07/06/11 Page 29 of 48
Objection.
29
Vague and foundation and
relevance.
THE COURT:
Sustained.
Q.
result, then, of course, the patient should be called, correct?
A.
will impact the patient's health before the next scheduled
visit, yes, the patient should be called.
Q.
10
BY MR. RICHARDS:
So if a doctor is aware of a
If a doctor has knowledge of an abnormal result that
But you wouldn't fault the doctor, would you, if he
or she was unaware of the result, right?
11
MR. FERRARI:
12
THE COURT:
Objection.
Sustained.
13
Q.
BY MR. RICHARDS:
14
require to know the -- you are assuming that the doctor is not
15
a victim of a fraud, isn't that true?
16
MR. FERRARI:
17
THE COURT:
In the standard of care it does
Objection.
Foundation.
Sustained.
18
Q.
BY MR. RICHARDS:
If you would go to 173-15, please.
19
Do you see this?
20
A.
Correct.
21
Q.
So that's not professional to have an unsigned test
22
in there, correct?
23
A.
It would not pass muster in my work environment.
24
Q.
By you looking at an unsigned test, we don't know
25
that Dr. Prakash saw this test, correct?
This isn't even signed, right?
Filed 07/06/11 Page 30 of 48
30
A.
No, we don't.
Q.
If we can go to 175-24, please.
Assume that's Sol Teitelbaum's signature.
doctor that's commenting on this order form, correct?
A.
No.
Q.
So all this means to -- all this means to you is that
assuming that signature is a licensed physician with no prior
record, Sol Teitelbaum, assume that he made that referral, then
you wouldn't be able to tell from this that another physician
You see here?

There is no other
10
validated that referral, would you?
11
A.
12
the very top of it it says that the ordering physician was
13
Dr. Popov.
14
Q.
15
billing purposes, do you?
Well, what's curious about this particular form is at
But you don't know if that's for Medicare purposes or
16
MR. FERRARI:
Objection.
Foundation.
17
THE COURT:
18
THE WITNESS:
This appears --
19
MR. FERRARI:
Objection.
Sustained.
20
Q.
BY MR. RICHARDS:
21
form?
22
A.
Not this specific form, no.
23
Q.
So you don't know whether this is a Medicare or a
24
billing-type form, do you?
25
A.
No.
Have you ever used this specific
Just asking if you know.
I can only surmise.
Filed 07/06/11 Page 31 of 48
31
Q.
You don't do your own Medicare billing, do you?
A.
No.
Q.
When was the last time you actually worked in the
private sector where you actually supervised a biller yourself?
MR. FERRARI:
THE COURT:
THE WITNESS:
Objection.
Relevance.
Overruled.
I'm not aware of many physicians that
supervise their billers.
Q.
BY MR. RICHARDS:
10
A.
No.
11
Q.
But I mean the billing company looks at the chart and
12
then does the bills, correct?
13
A.
Correct.
14
Q.
You don't sit there and go over the bills to
15
Medicare, do you?
16
A.
No.
17
Q.
And if a biller was dishonest and submitted false
18
bills, it would be hard for you to figure it out for awhile,
19
wouldn't it?
They subcontract to a billing company.
20
MR. FERRARI:
21
THE COURT:
22
Q.
23
please.
24
25
They do it on their own, right?
Objection.
Foundation.
Sustained.
BY MR. RICHARDS:
Now, if you can go to 175-25,
Here, there is no technologist on here signing that,

correct?
Filed 07/06/11 Page 32 of 48
32
A.
Correct.
Q.
So we don't know if -- when this file was submitted
to Medicare, we don't know if Dr. Prakash or Dr. Popov ever saw
this file?
5
6
MR. FERRARI:
Objection.
Foundation.
Assumes facts
not in evidence.
THE COURT:
Sustained.
Q.
BY MR. RICHARDS:
When you see a blank abdominal
study, you can't really tell if any doctor ever saw this
10
without a signature of theirs acknowledging that they saw it,
11
correct?
12
MR. FERRARI:
13
THE COURT:
Objection.
Sustained.
14
Q.
BY MR. RICHARDS:
Would it pass master in
15
Dr. Neyhart's office having a blank technological signature on
16
the file?
17
A.
18
not be a technologist signature.
19
Q.
20
earlier, right?
21
A.
No.
22
Q.
Are you aware that the charts in this case that
23
relate to Dr. Prakash are littered with stickers where
24
Dr. Prakash -- where there's indications of quality assurance
25
and issues?
If there is a radiologist interpretation, there need
But you didn't see one when you testified about this

1
2
MR. FERRARI:
33
Filed 07/06/11 Page 33 of 48
Objection.
Foundation.
Assumes facts
not in evidence.
THE COURT:
Sustained.
Q.
And I'm just showing you here.
This is again another -- if we
can just highlight down here.
I just wanted to point that out.
BY MR. RICHARDS:
If you can go to 172-18, please.
It says, difficulty to obtain the left kidney for
mass, GB contradicted.
What does that mean?
A.
I actually reads "GB contracted."
10
Q.
Contracted.
11
A.
The gallbladder is often abbreviated as GB.
12
being contracted is something I often see in ultrasonography
13
reports, and I believe that that speaks to the extent to which
14
the patient was prepped before the examination.
15
Q.
16
doctor, we don't know if that test ever occurred, correct?
What does that mean?
But because there is no radiology analysis by a
17
MR. FERRARI:
18
THE COURT:
19
Q.
20
The GB
Objection.
Foundation.
Sustained.
BY MR. RICHARDS:
If we can take that off, please.
Going back to the stress test.
Isn't a stress test
21
risky and time consuming?
22
A.
Yes.
23
Q.
And it's typically not done on the first visit,
24
correct?
25
A.
It's not done, but it is ordered if indicated.
Filed 07/06/11 Page 34 of 48
Q.
where the pulmonary function test was ordered.
If we can go to 171-41, please.
34
This is a chart
What test should have been ordered that you think, as
to this patient, that wasn't ordered?
A.
context of what were the complaints and what were the physical
findings.
Q.
Well --
A.
I'm certain it is in the body of my report, however.
10
Q.
Wasn't a pulmonary function test ordered here?
11
A.
I see a check corresponding to pulmonary function
12
test.
13
Oh, heavens, I would have to review that file in the
THE COURT:
14
20 minutes.
15
gentlemen.
We'll take our recess.
Return in
Please remember the admonitions, ladies and

Court is in recess.
16
(Jury out.)
17
(Break taken.)
18
(Jury in.)
19
THE COURT:
Before we go back to examination, ladies
20
and gentlemen, I understand there's some question about the
21
dates that I gave you.
22
What I've said is that this trial will be concluded
23
as far as evidence, oral argument, and instruction not later
24
than the 15th.
25
very latest by the 15th.
Meaning that you will be deliberating at the

It may be before then.

1
35
Filed 07/06/11 Page 35 of 48
But if you ask if that will be the conclusion of
evidence, evidence must conclude at least the day before so I
can get prepared for the instructions and the arguments that
will be given to you.
of time for their final argument.
of time that each side will have as well.
Each side will be given a limited period

I will tell you the length
So at some point in time, which we'll know a little
bit closer as we move down further, there will be the end of
evidence as you have it, there may be a day off, there may not
10
be.
We may work that evening.
11
back the next day, you'll start out with closing argument from
12
the Government, closing argument from all three defense, any
13
rebuttal closing argument.
14
then you will start to deliberate.
15
But regardless, when we come
I will instruct you on the law, and
All of that will happen no later than the 15th.
16
That's what I'm saying.
17
Thank you.
18
Q.
19
But it could be sooner than that.
Proceed.
BY MR. RICHARDS:
Thank you.
Turn to 171-40, please.
On this page I just want to establish, is this a
20
referral to a cardiologist down at the bottom there?
Do you
21
want me to enlarge it?
22
A.
23
cardiology.
24
Q.
25
practitioners don't like to do stress tests at the office?
If we can just enlarge that.
How it reads is, note patient to be referred to
All right.
And isn't it true that generally family

1
MR. FERRARI:
THE COURT:
Filed 07/06/11 Page 36 of 48
Objection.
36
Foundation.
Sustained.
Q.
BY MR. RICHARDS:
Let me give you a hypothetical.
If
someone does a stress test and has a heart attack as a result
of the stress test, would it be better off that they're in the
office of a cardiologist or an internist?
A.
resuscitate a patient in that particular event but not
necessarily.
A cardiologist is typically better prepared to
10
Q.
So a family practitioner is better off than a
11
cardiologist for a heart attack?
12
MR. FERRARI:
13
THE COURT:
Objection.
Vague.
Sustained.
14
Q.
BY MR. RICHARDS:
Can you turn to 177-41, please.
15
Earlier you testified in the chief complaint section that you
16
found that the person complaining about varicose veins was --
17
you didn't like that because you didn't think that was a
18
complaint.
Remember that testimony?
19
MR. FERRARI:
20
THE COURT:
Objection.
Misstates her testimony.
Sustained.
21
Q.
BY MR. RICHARDS:
Isn't it true that varicose veins,
22
you know, the veins people don't like on their legs, or arms,
23
or what have you, is a common complaint amongst elderly people?
24
A.
25
about these ugly veins."
People commonly say "and is there anything you can do

Yes.
37
Filed 07/06/11 Page 37 of 48
Q.
So by looking at this comprehensive history, we don't
even know who wrote that in there, right?
A.
wrote in section number three and section number four.
the charts we have been operating under the assumption that
this is text entered by the clinician.
Q.
writing the words ugly veins, just changes it to varicose
veins, that that's inappropriate?
In all the charts it is presumed that the clinician

In all
Are you suggesting that if a clinician, instead of
10
A.
11
bilateral lower extremities" is not the way somebody would --
12
the way a patient would tend to present their ugly veins.
13
Q.
14
written, there's nothing wrong with characterizing that as a
15
complaint, is there?
16
A.
17
the legs and verification that there were varicosities, and
18
that they were bilateral.
19
20
No.
I'm saying that stating "mild varicosities of
And I'm just saying in that section where it's
Only that it implies that there was an inspection of
MR. RICHARDS:
All right.
I'm going to mark as 817,
Defendant's 817.
21
(Defendants' Exhibit 817, Generic drug prescription
22
instructions for clonidine, marked for identification.)
23
Q.
BY MR. RICHARDS:
24
A.
Yes, I have.
25
MR. RICHARDS:
Have you heard of Catapres?
It is brand name clonidine.

May I approach the witness, Your

1
THE COURT:
Q.
prescription record.
right-hand corner?
You may.
BY MR. RICHARDS:
I'm showing what is the
Do you know the company on the upper
MR. FERRARI:
Can I see what you're showing the
witness?
MR. RICHARDS:
MR. FERRARI:
10
11
38
Honor?
Filed 07/06/11 Page 38 of 48
Yeah.
Just the manufacturer.
Do you have a copy for me?
MR. RICHARDS:
I just pulled it off the internet, so
I can just print --
12
MR. FERRARI:
So you don't have a copy for me?
13
MR. RICHARDS:
Well, I can give you one after court.
14
Q.
BY MR. RICHARDS:
15
In the upper right-hand corner, that's the manufacturer,
16
correct?
17
MR. FERRARI:
18
THE COURT:
If you would take a look at this.
Objection.
Sustained.
19
Q.
BY MR. RICHARDS:
20
like a prescription treatment record from the manufacturer?
21
MR. FERRARI:
22
THE COURT:
Does that document, to you, look
Objection.
Sustained.
23
Q.
BY MR. RICHARDS:
What is that document?
24
A.
This document appears to be something put out by the
25
manufacturer describing their product.
Filed 07/06/11 Page 39 of 48
Q.
Are you familiar with this product?
A.
Yes, I am.
Q.
And do you know that to be the Catapres that's the
brand name -- is that what you know to be the brand name for
Klonopin?
A.
Not for Klonopin.
Q.
under dosage.
That is the brand name for the generic clonidine.
Clonidine.
Sorry.
If you can go to the third page
What dosage is that manufacturer dealing with?
10
MR. FERRARI:
11
THE COURT:
Objection.
Foundation.
Sustained.
12
Q.
13
you -- does that look consistent with you with the
14
manufacturer's instructions for that drug?
BY MR. RICHARDS:
15
MR. FERRARI:
16
THE COURT:
17
THE WITNESS:
18
By looking at that document, can
Objection.
This appears to be the manufacturer's
recommended dose.
MR. RICHARDS:
20
MR. FERRARI:
All right.
Objection.
I move to admit 817.

Hearsay.
Relevance.
Foundation.
22
THE COURT:
Relevance.
23
Q.
24
dose, that's for .1 milligrams?
25
Foundation.
Overruled.
19
21
39
BY MR. RICHARDS:
MR. FERRARI:
Sustained.
If you look at the recommended
Objection.
Hearsay.

1
THE COURT:
Filed 07/06/11 Page 40 of 48
40
Sustained.
Q.
BY MR. RICHARDS:
earlier about the recommended -- that you testified that the
recommended dose -- you felt the patients weren't getting
enough on the first day?
MR. FERRARI:
THE COURT:
Do you remember your testimony
Objection.
Vague.
Sustained.
Q.
BY MR. RICHARDS:
Do you remember being critical of
the amount of clonidine the patients were getting?
10
A.
I remember being critical about the frequency of
11
dosing.
12
Q.
13
.1 milligrams, correct?
14
A.
Correct.
15
Q.
And if you look at the third page, isn't it true that
16
the manufacturer says to give less doses if they're elderly?
The frequency.
17
MR. FERRARI:
18
THE COURT:
And in the chart it was
Objection.
Hearsay and relevance.
Sustained.
19
Q.
BY MR. RICHARDS:
20
manufacturer is suggesting for elderly patients?
21
MR. FERRARI:
22
THE COURT:
Do you disagree with what the
Objection.
Hearsay and relevance.
Sustained.
23
Q.
BY MR. RICHARDS:
In the course of your evaluation,
24
do you read the manufacturer's recommended dose?
25
A.
In the course of my evaluation?
Filed 07/06/11 Page 41 of 48
Q.
the manufacturer recommends?
A.
Yes, I do.
Q.
I'm assuming you've read for Catapres what the
manufacturer recommends, correct?
A.
dose of this particular drug, yes.
Q.
less frequency if they're elderly?
Of prescribing this drug as a doctor do you know what
I'm familiar with appropriate dosing and appropriate
So isn't it true that the manufacturer says to give a
10
MR. FERRARI:
11
THE COURT:
Objection.
Hearsay.
Sustained.
12
Q.
13
different if they're elderly versus non-elderly?
BY MR. RICHARDS:
14
MR. FERRARI:
15
THE COURT:
16
Q.
41
Do you think the dosage is
Objection.
Vague.
Sustained.
BY MR. RICHARDS:
17
MR. FERRARI:
18
THE COURT:
Of clonidine?
Objection.
Vague.
Sustained.
19
Q.
BY MR. RICHARDS:
20
elderly person or a non-elderly person, is there a difference
21
in the dosage according to the manufacturer?
22
MR. FERRARI:
23
THE COURT:
24
Q.
25
pseudodementia is?
.1 milligrams of clonidine for an
Objection.
Hearsay and vague.
Also relevance.
BY MR. RICHARDS:
Sustained.
Now, do you know what
Filed 07/06/11 Page 42 of 48
A.
Yes, I do.
Q.
And isn't it true that iron B-12 and thyroid levels
are necessary to treat pseudodementia?
A.
pseudodementia.
Q.
assists with helping them get treated for pseudodementia?
42
Ordering those levels is not involved in treating
Isn't it true that you give iron B-12 to someone that
MR. FERRARI:
THE COURT:
Objection.
Relevance.
Sustained.
10
Q.
BY MR. RICHARDS:
You were critical in your analysis
11
that iron B-12 tests were ordered.
12
A.
13
a test called a B-12 test.
14
Q.
And you were critical that iron tests were ordered?
15
A.
As initial studies, yes.
16
Q.
But isn't it true that treatment with iron or B-12
17
can help pseudodementia?
Do you remember that?
There was a test called an iron test, and there was
18
MR. FERRARI:
19
THE COURT:
They are different tests.
Objection.
Relevance.
Sustained.
20
Q.
BY MR. RICHARDS:
21
Dr. Teitelbaum was available for an interview?
22
MR. FERRARI:
23
THE COURT:
Did you ever ask the Government if
Objection.
Relevance.
Sustained.
24
Q.
BY MR. RICHARDS:
Let me give you a hypothetical.
25
When you're evaluating doctors -- other doctors' work, isn't
Filed 07/06/11 Page 43 of 48
it, hypothetically, better if you can interview the doctors
that observed the patient directly?
MR. FERRARI:
THE COURT:
Objection.
Vague.
43
Relevance.
Sustained.
Q.
retained to evaluate the standard of care, isn't that correct?
A.
Yes.
Q.
So, hypothetically, if patients were giving false
information to the doctor, can you still evaluate a doctor's
10
BY MR. RICHARDS:
In this case, you said you were
standard of care?
11
MR. FERRARI:
Objection.
12
MR. RICHARDS:
13
THE COURT:
Foundation and vague.
A hypothetical.
Sustained.
14
Q.
15
hypothetical.
16
and withholding their general primary care physician, and
17
withholding their past medical history, and withholding their
18
Medicare -- or their medications that they're on, would you
19
still be able to evaluate their standard of care?
20
21
BY MR. RICHARDS:
If the patients are coming to a doctor's office
MR. FERRARI:
Objection.
THE COURT:
23
MR. RICHARDS:
25
Foundation, vague and
relevance.
22
24
I just want to give you a
Sustained.
I'm just trying to give a
hypothetical.
THE COURT:
Sustained.

1
Q.
hypothetical.
unbeknownst to the doctor, would you still be able to evaluate
their standard of dare?
would you still be able to evaluate the standard of care?
6
7
BY MR. RICHARDS:
44
Filed 07/06/11 Page 44 of 48
I'll try to give you another
If the patient histories were being created
MR. FERRARI:
Hypothetically, if that was occurring,
Objection.
Vague, foundation and
relevance.
THE COURT:
Sustained.
MR. RICHARDS:
Can I have the grounds, Your Honor, so
10
I don't ask the same question?
11
THE COURT:
Sustained.
Move on.
Move to a different
12
area.
13
Q.
14
laboratory report that you indicated was -- had low HGB.
15
you remember that testimony?
16
A.
Yes, I do.
17
Q.
But you don't see anywhere on the report that
18
Dr. Prakash ever saw these results, do you?
19
A.
I see no indication that he saw them.
20
Q.
And with respect to -- you testified earlier that you
21
saw a signature that you saw as "R. Prakash."
22
that testimony?
BY MR. RICHARDS:
23
MR. FERRARI:
24
THE COURT:
25
Q.
If you can go to 184-63.
Objection.
This is a
Do
Do you remember
Vague.
Sustained.
BY MR. RICHARDS:
Let me just clarify.
You don't
Filed 07/06/11 Page 45 of 48
know what Dr. Prakash's signature is, do you?
A.
Dr. Prakash sprinkled throughout the records that I reviewed.
Q.
you?
45
I know that there were signatures that appear to be
But you don't know if those were forgeries or not, do
MR. FERRARI:
THE COURT:
Objection.
Foundation.
Sustained.
Q.
BY MR. RICHARDS:
I'm just establishing.
For the
purposes of your evaluation, you're assuming that every
10
signature that says "R. Prakash" was actually signed by R.
11
Prakash, correct?
12
A.
13
signature that I could not be certain the authorship of, and I
14
would say "it appears to be."
15
In my report, I was very specific when I saw a
So at no point did I draw any conclusions that
16
Dr. Prakash was the author of illegible signatures.
17
Q.
18
signature.
19
"R. Prakash."
20
21
Yeah.
I'm not talking about an illegitimate (sic)
I'm talking about a signature where you can read
Isn't it true that your report assumes that

"R. Prakash" was actually signed by Dr. Ramanathan Prakash?
22
MR. FERRARI:
23
THE COURT:
Objection.
Relevance.
Sustained.
24
Q.
BY MR. RICHARDS:
When you were able to read the
25
signature, you assumed that the actual doctor did in fact sign
46
Filed 07/06/11 Page 46 of 48
that portion of the chart, correct?
A.
Yes.
Q.
And, hypothetically, if I were to tell you that that
signature -- or if you were to find out that that signature was
not Dr. Prakash's, would that change your assessment of the
standard of care?
MR. FERRARI:
THE COURT:
9
10
Q.
Objection.
Foundation.
Relevance.
Sustained.
BY MR. RICHARDS:
You can go to 177-43.
When you
kept pointing out -- strike that.
11
When you kept seeing that these patients refused
12
exams, more invasive exams, isn't it true that you never asked
13
to interview any of these patients?
14
MR. FERRARI:
15
THE COURT:
Objection.
Relevance.
Sustained.
16
Q.
BY MR. RICHARDS:
17
good idea to interview patients to find out why they did
18
certain things if you were evaluating the standard of care?
19
MR. FERRARI:
20
THE COURT:
Hypothetically, wouldn't it be a
Objection.
Relevance.
Sustained.
21
Q.
BY MR. RICHARDS:
Can we go to 175-55, please.
On
22
this example you were critical of the creatine level being too
23
high.
24
A.
Yes.
25
Q.
Did you ever try to figure out whether or not or what
Do you see that?

The creatinine level is elevated.
Filed 07/06/11 Page 47 of 48
the reason is why there is no indication that the physician
actually saw this lab result?
MR. FERRARI:
THE COURT:
Objection.
Sustained.
Q.
generally speaking, for the Medical Board, isn't it true that
you've never evaluated a doctor's standard of care when the
information the doctor was receiving was false or fictitious?
BY MR. RICHARDS:
MR. FERRARI:
10
When you're evaluating -- just
Objection.
THE COURT:
Sustained.
11
Q.
12
Medical Board -- strike that.
13
BY MR. RICHARDS:
When you evaluate doctors for the
I'm assuming you pulled Dr. Prakash's medical history
14
with the Medical Board before you evaluated his standard of
15
care, didn't you?
16
MR. FERRARI:
17
THE COURT:
Objection.
Relevance.
Sustained.
18
Q.
19
doctor's had any history of problems with patients?
BY MR. RICHARDS:
20
MR. FERRARI:
21
THE COURT:
Is it important to know if the
Objection.
Vague and relevance.
Sustained.
22
Q.
23
specific protocol that you use when you're evaluating the
24
standard of care for doctors?
25
47
BY MR. RICHARDS:
MR. FERRARI:
With respect to -- do you have a
Objection.
Vague.

1
THE COURT:
Filed 07/06/11 Page 48 of 48
Sustained.
Q.
evaluate the standard of care, isn't it true that you're
assuming that all the data the doctor is looking at is
accurate?
BY MR. RICHARDS:
MR. FERRARI:
THE COURT:
When you're looking at files to
Objection.
Relevance.
Vague and relevance.
BY MR. RICHARDS:
Sustained.
Q.
standard of care and were told that the doctor was relying on
10
Have you ever evaluated a doctor's
incomplete or fictitious information?
11
MR. FERRARI:
12
THE COURT:
Objection.
Sustained.
Relevance.
It's also 403.
Counsel, this
13
line of questioning is being substantially outweighed by the
14
waste of time and confusion of the issues.
15
16
As you said previously, this is not a malpractice

case.
This is a criminal case.
Move on.
17
MR. RICHARDS:
18
(End of partial transcript.)
19
CERTIFICATION
20
48
I don't have anything further.
I, Diane J. Shepard, certify that the foregoing is a
21
correct transcript from the record of proceedings in the
22
above-entitled matter.
23
24
25
/s/ DIANE J. SHEPARD

DIANE J. SHEPARD, CSR #6331, RPR
Official Court Reporter
United States District Court

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Case 2:08-cr-00427-MCE Document 440

Filed 07/06/11 Page 1 of 48

IN THE UNITED STATES DISTRICT COURT

---oOo--REPORTER'S PARTIAL TRANSCRIPT

DIANE J. SHEPARD, CSR #6331, RPR

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 440

Filed 07/06/11 Page 2 of 48

For the Government:

For the Defendant, Lana Le Chabrier

For the Defendant, Alexander Popov:

For the Defendant, Ramanathan Prakash:

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 440

Filed 07/06/11 Page 3 of 48

MONDAY, JUNE 27, 2011

BARBARA NEYHART, M.D.,

a witness called by th1e Government, having been first duly

nothing but the truth, testified as follows:

fraudulent billing files to Medicare, have you?

And the second set of charts that you have in front

weren't randomly selected, were they?

me to be an expert in this case.

Phil Ferrari, right?

Would you be surprised to know the second set of

charts were the second substantive counts that my client

Dr. Prakash was charged with?

Dr. Neyhart, you've never worked on detecting

They were provided to me by the attorney who called

I'm sorry, sir.

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 440

Filed 07/06/11 Page 4 of 48

in all the charts that the Government has?

ask if those charts were cherry-picked for you?

So did you ever ask the Government if you can go

Did you ever ask

I never asked, but that information was provided to

Misstates the record.

How many charts are over there, do

want you to look at?

Now isn't it true you've never done any research on

fraudulently created for Medicare submissions?

I had no occasion to do so.

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 440

Filed 07/06/11 Page 5 of 48

And isn't it true that elderly people have more organ

failures than younger people?

Yes, that is correct.

at doctors' work for the Medical Board, correct?

And I listened very carefully during that testimony,

and you said "I listen to interviews of the doctor," correct?

And when you review a doctor's work, it would be

great to interview the doctor, wouldn't it?

I'm provided with an interview that was conducted by another

that it's very helpful to listen to what the doctor's

It's helpful but not critical.

Out of all the doctors that you've evaluated, how