On September 24, 2009, clinic owners and operators Jose Martinez and Denise Martinez pleaded guilty at the U.S. District Court in Detroit to participating in a conspiracy to defraud the Medicare program, announced government attorneys Assistant Attorney General Lanny A. Breuer of the Criminal Division, U.S. Attorney Terrence Berg of the Eastern District of Michigan and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS) announced.
Jose Martinez, 33, and Denise Martinez, 27, each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Victoria Roberts. At sentencing, which is scheduled for February 18, 2010, both defendants face a statutory maximum of 10 years in prison and a $250,000 fine.
According to court documents Jose Martinez, in September 2006, opened RDM Center Inc., a Canton, Michigan, medical clinic purporting to specialize in providing injection and infusion services to Medicare beneficiaries. Jose Martinez’s then-wife, Denise Martinez, managed and operated the clinic.
Martinez hired a physician and other employees to work at RDM Center in order to create the appearance that the clinic was a legitimate health care facility providing necessary services to patients. However, the clinic routinely billed the Medicare program for services that were medically unnecessary or never provided. Both defendants admitted that they purchased only a small fraction of the medications for which the clinic billed the Medicare program. Both defendants also admitted that patients were prescribed medications at the clinic based not on medical need, but on which medications were likely to generate Medicare reimbursements.
How did they pull this off? The “patients” were in on the scam. The so-called patients were not referred by legitimate doctors but instead were bribed with cash and drugs to pretend they received medications and treatments, when in fact, they did not. Medicare paid almost $700,000.00 of those false claims.
Readers are reminded to make sure the clinics they use are legitimate by getting referrals from doctors and using approved lists from their HMOs. If you have questions or are suspicious of a facility, check with the Health Care Fraud Prevention and Enforcement Action Team, or “HEAT,” at: www.stopmedicarefraud.gov.
Carlos L. McDade, Esq.