Salinas pain doc charged with fraud, writing illegal prescriptions.

Salinas pain physician Steven Mangar was arrested in his Romie Lane office, Pacific Pain Care, Tuesday morning on 37 felony charges of fraud and writing illegal prescriptions. Mangar was booked in Monterey County Jail, where he's currently being held on $1 million bail. 

Investigators with the Monterey County District Attorney's office gathered tens of thousands of pieces of evidence, including insurance claims filed by Mangar's practice, and interviews with more than 100 patients, as well as medical records. 

Twenty-six counts against him allege he defrauded insurance companies, ultimately over-billing for more than $500,000 since 2008. 

Mangar also faces 11 charges of writing unlawful prescriptions for drugs including the narcotic painkiller oxycodone (including the brand OxyContin), hydrocodone (often sold as brands Vicodin and Norco), morphine and other addictive medications.

The DA's complaint identifies 25 victims of these alleged crimes, identified as John Doe and Jane Doe to protect their privacy. 

Mangar has not yet retained an attorney on these charges, but Salinas defense attorney Susan Chapman, who is representing him in a separate DUI case, says she expects to appear in court on Mangar's behalf on these charges as well. She expects he will enter a plea of not guilty, and adds, "We look forward to presenting his case in court."

The California Medical Board, which has the power to revoke physicians' licenses, has been notified of Mangar's arrest and the charges against him. 

The medical board has been examining Mangar for years, and the DA's office and California Department of Insurance later joined in the investigation.

The medical board issued its first disciplinary order against Mangar in 2012, when he was placed on probation. As part of a settlement agreement, he acknowledged he had failed to keep adequate records. 

In 2013 he was cited for violation of probation, and then another complaint followed on Jan. 7 of this year based on numerous patients lodged against him. 

Consider the case of R.M., a 40-year-old man suffering from lower back pain due to a ruptured disc and degenerative disc disease, whose story is detailed in a complaint filed by the medical board against Mangar on Jan. 7. 

R.M. was referred to Pacific Pain Care in 2008, where Mangar prescribed a regimen of opioids. But his condition failed to improve, according to the complaint; instead, he had trouble staying awake, and ultimately urged Mangar to prescribe him more than the daily maximum dosage of 80 milligrams of Ritalin, a stimulant. 

Another patient, 43-year-old K.B., first came to see Mangar in 2010 suffering from rheumatoid arthritis. Medical board investigators found her initial exam results were not included in her chart, making it impossible to accurately track her progress. 

What they do know is that her progress included difficult bouts of depression and anxiety, and she began abusing multiple medications, including Norco. Her chart showed prescription refills without even face-to-face exams, according to the complaint. 

Then there was 33-year-old A.H., who first came to Pacific Pain Care in 2012 and reported a work injury caused him continuous lower back pain. "[Mangar's] limited physical examination included a finding of decreased lumbar lordosis, but was generally within normal limits," according to the complaint. 

Still, the doctor prescribed A.H. methadone and Norco. 

Five days later, the young man's parents brought him to the hospital for trouble breathing and bluish-colored skin. They reported his had a history of substance abuse.

A.H. was revived with Narcan, but was found dead in his bed the following day. A pathologist later determined he died of methadone and hydrocodone intoxication. 

The tragic list goes on, detailing lives destroyed and lost. 

While insurance companies are technically the victims in the 26 counts of fraud, Deputy District Attorney Amy Patterson, who oversees the DA's health care fraud unit, says patients are affected too: "When the insurance company gets defrauded, it affects their rates," she says. 

Since launching the health care fraud unit in 2014, this is its biggest case, Patterson says. "To my knowledge, it's one of the largest doctor fraud cases we've ever had in our county."