04/05/2010

News / Detroit-Area Doctor and Patient Recruiter Convicted in Medicare Fraud Scheme

Clinic Owners Moved from Miami to Detroit to Perpetrate Scheme

West Bloomfield, Mich., physician Alan Silber and Detroit resident Hassan Reeves were convicted today by a federal jury for their roles in an $1 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services, Office of Inspector General’s (HHS-OIG) Chicago Regional Office.

After a week-long trial, the jury convicted Silber of six counts of health care fraud. Reeves was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay health care kickbacks. Silber was acquitted on one count of conspiracy to commit health care fraud. Each substantive health care fraud charge and the conspiracy charge carry a maximum penalty of 10 years in prison and a $250,000 fine. The charge of conspiracy to pay health care kickbacks carries a maximum penalty of five years in prison and a $250,000 fine. Sentencing has been scheduled for Aug. 6, 2010.

Evidence at trial established that beginning in approximately December 2006, Silber and Reeves began working at a purported infusion clinic called RDM Center Inc. RDM Center existed for the purpose of causing fictitious claims for injection and infusion therapy services to be billed to Medicare. Evidence at trial established that the owners of RDM Center, Miami residents Denisse and Jose Martinez, came to Detroit to start the clinic because of heavy law enforcement scrutiny in Florida of fraudulent infusion clinics. Evidence presented at trial showed that Silber was hired to be the physician at the clinic while Reeves was hired to recruit and pay kickbacks to Medicare beneficiaries to come to the clinic. Denisse and Jose Martinez have previously pleaded guilty for their roles in the scheme.

During the time that RDM Center was open, the clinic routinely billed the Medicare program for services allegedly performed, but in reality were medically unnecessary and/or never provided. Trial evidence showed that the clinic’s owners purchased only a small fraction of the medications for which the clinic billed the Medicare program. According to evidence presented at trial, medications at the clinic were prescribed based not on medical need, but based on what medications were likely to generate Medicare reimbursements. Denisse Martinez, despite having no medical training, completed the clinic’s patient records by filling in, among other things, the "diagnosis" and "treatment" sections of the patient charts, which were then provided to Silber for his signature. Evidence presented at trial showed that Silber signed the diagnosis and treatment forms even though he neither made the diagnosis nor made any independent medical judgment as to the course of treatment. Expert testimony established that there was no legitimate medical basis for the use of the medications that Silber approved at the clinic, and, that in several instances, the medications could have harmed the patients. Evidence at trial established that Silber routinely approved the use of medications for patients despite knowing that the medications were unnecessary.

Evidence at trial also established that Medicare beneficiaries were not referred to RDM Center by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited by Reeves to come to the clinic through the payment of kickbacks. Reeves recruited the beneficiaries in downtown Detroit and drove them approximately 27 miles to RDM Center. Trial evidence showed that in exchange for the kickbacks Reeves paid them, the Medicare beneficiaries visited the clinic and signed documents indicating that they had received the services billed to Medicare. Kickbacks came in the form of cash and prescriptions for controlled substances.

Between approximately December 2006 and March 2007, Silber, Reeves and their co-conspirators caused the submission of approximately $970,631 in false and fraudulent claims to be submitted to the Medicare program for services supposedly provided by RDM Center. Medicare actually paid approximately $649,000 of those claims

The case was prosecuted by Trial Attorney Benjamin D. Singer of the Criminal Division’s Fraud Section and Special Assistant U.S. Attorney Thomas W. Beimers of the U.S. Attorney’s Office for the Eastern District of Michigan.

The FBI and HHS-OIG conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

http://www.justice.gov/opa/pr/2010/April/10-crm-366.html

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