Painful Mistakes

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We’ve all made painful mistakes. (Whether buying something we can’t afford, forgetting a significant other’s birthday, or forgetting to set an alarm for an early morning flight, there are always consequences for our actions whether intentional or not.) Today’s ”Fraud of the Day” details the story of a Delaware doctor who claims he mistakenly trusted the wrong people and is now in a quite a bit of trouble regarding his pain clinic’s billing practices.

An article in the Delaware State News states that the pain doctor’s clinic was investigated by the state’s Medicaid Fraud Control Unit for several patterns of fraud over a two-year period. Investigators found that he billed for services never rendered, submitted claims for unnecessary services and testing, billed for tests and equipment provided by an outside vendor, and filed claims with incorrect codes in order to receive higher reimbursement amounts.

The anesthesiologist pleaded guilty to one count of felony health care fraud for fraudulent billing practices. As a result, he was sentenced to 18 months of probation and ordered to pay restitution of $250,000 to the Delaware Division of Medicaid and Medical Assistance plus a $50,000 fine. In addition, he has to pay $10,000 to the Delaware Medicaid Fraud Control Unit that conducted his lengthy investigation and perform 200 hours of volunteer service. (There’s also a chance he will face disciplinary action by his state’s medical licensing board.)

While in court, the pain doctor was overwhelmed by emotion and became unable to read a prepared statement. (At least it appears he was remorseful.)His lawyer finished reading the statement that admitted the doctor trusted the wrong people and it was not his intention to defraud his state’s health program. (Kudos to him for taking responsibility.)

The purpose of the Delaware Division of Medicaid and Medical Assistance is to provide health care coverage for low-income and disabled beneficiaries, not line the pockets of deceptive providers. (While good people can make mistakes, this one is likely to be a painful reminder of the Hippocratic oath he took when he first became a doctor—first, do no harm.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Dover doctor pleads guilty to felony health care fraud,” published by the Delaware State News on June 27, 2016.

DOVER — A Dover pain doctor was sentenced to 18 months of probation Monday after pleading guilty to one count of felony health care fraud involving fraudulent billing practices.

Dr. Senad Cemerlic, an anesthesiologist and owner of ABG Pain Clinic, was ordered to pay $250,000 in restitution to the state Division of Medicaid and Medical Assistance and a $50,000 fine. He also must pay $10,000 to cover the cost of the investigation that began last in year in response to a tip to the state Medicaid Fraud Control Unit.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.