Cash and prescriptions for controlled-substances lured the patients — greed lured the doctor. Physician Alan Silber could spend sixty years (essentially the rest of his life) in jail and pay fines of as much as $1.5 million dollars for his role in a Medicare fraud scheme at a Detroit infusion clinic. According to the jury findings, Silber signed just about anything put in front of him by patient-recruiter Hassan Reeves, who could receive up to 15 years for her part of the fraud. According to DoJ:

“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.”

Denisse and Jose Martinez previously pleaded guilty to orchestrating the scheme. The clinic billed Medicare for large amounts of medicine that was never purchased much less provided to beneficiaries. Every decision made was based upon likelihood of Medicare reimbursement — not medical necessity. In fact, Denisse and Jose — who had no medical training themselves — made most of the diagnosis and treatment decisions. It made little difference if they were wrong, because the treatments were rarely administered and the patients were rarely at the clinic out of true medical need. They came from the streets of downtown Detroit, lured by Reeves who paid them in cash and prescriptions for narcotics and sometimes drove them to the clinic nearly thirty miles in her own car. Dr. Silber asked no questions — apparently he just signed the papers and picked up his paycheck. The jury heard evidence 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.”

All told, nearly a million dollars of false claims were presented for payment before the Medicare fraud ring was caught. Silber and Reeves will be sentenced on August 6, 2010.

FraudBlawg UPDATE: DENISSE AND JOSE MARTINEZ SENTENCED.

To report Medicare fraud, contact Frohsin & Barger.