Senad Cemerlic, MD, an anesthesiologist and owner of ABG Pain Clinic in Dover, DE, pleaded guilty June 27, 2016 to one count felony health care fraud. He was sentenced to 18 months of probation, $250,000 in restitution, $60,000 in fines and 200 hours of community service. Dr. Cemerlic was arrested 9 months ago on six counts of felony health care fraud after a lengthy investigation into his billing from November 2012 to September 2013. According to the government there were “extensive patterns of fraud, including billing for services that were never provided and submitting claims for services and testing that weren’t medically necessary.” Included in that was also using higher reimbursement codes than the actual procedures performed and billed for tests and equipment provided by an outside laboratory.
So then why were there only 6 counts? Every doctor in this country commits the billing infractions named here, because it doesn’t matter what you do, the government can come back after the fact and say the tests or treatments weren’t medically necessary. They did the same thing to me, and I was one of the most careful physicians when it came to billing, and one of the cheapest, as I was extremely frugal with tests and never ordered anything that wasn’t necessary.
I think the entire reason for attacking Dr. Cemerlic was that he ran a pain management clinic and was probably independent even though he was an anesthesiologist, and this was an easy way to shut him down.
Attorney General Matt Denn said “Fraudulent billing for services not rendered is one of the factors in health care costs being too high, and finding and prosecuting cases of Medicaid fraud is one of the key priorities I have set for our office.”
In fact, complete jobs in US Attorneys’ offices all over the country are created just for the purpose of attacking doctors for insurance fraud. First, they make the laws so vague, and change them at will so that at any given moment every doctor in the country is guilty of committing a felony. But that just gives them the leeway then to enter any doctor’s office they want and charge them with fraud. Then they target the easiest ones for charges—the independent physicians, often in rural areas. I personally think they can sniff out the possible targets by how many mistakes are on the claim forms, showing lack of management skills.
The win-win for the government in attacking a doctor such as Dr. Cemerlic is this:
- They get tons of money returned to them for the work he has legitimately done and should be paid for. That money goes back to Medicare/Medicaid and helps pay for the people doing the investigating.
- The doctor loses his license to practice because of the felony. He also loses his DEA certificate and can no longer prescribe controlled drugs. So another pain management clinic is closed down with very little cost and the rewards to the involved government personnel is large.
- The DEA has no intention of returning the Controlled Substance certificate to the doctor once it is given up.
People need to understand that doctors don’t intentionally bill wrong. The system is designed so that it has to happen, and just for this purpose—to pick and choose who to ruin FOR MONEY. It’s all about money, and now also closing down pain management clinics.