Dr. Senad Cemerlic, an anesthesiologist and owner of ABG Pain Clinic located at 1609 South State Street in Dover, was arrested on six counts of felony health care fraud on Sept. 22, 2015. The arrest follows a lengthy investigation by the Department of Justice Medicaid Fraud Control Unit into various billing schemes perpetuated between November 2012 and September 2013 at the clinic.
Following a tip to the Medicaid Fraud Control Unit hotline in 2013, an investigation was conducted into Dr. Cemerlic’s billing practices for patient in-office testing, examinations and treatment allegedly provided at the clinic. With the assistance of federal and state partners, including agents from the US Department of Health and Social Services, Office of Inspector General, DOJ investigators identified extensive patterns of alleged fraud throughout 2012 and 2013.
The alleged health care fraud by Dr. Cemerlic includes billing for services never provided to patients, submitting claims for services and testing that were not medically necessary, billing for tests and equipment provided by an outside laboratory vendor, and “upcoding,” or submitting claims for procedures and tests with higher reimbursement codes than the actual procedures or tests performed. The alleged fraudulent claims were submitted to the Delaware Medicaid program, as well as to Medicare and third-party private insurers.
“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,” said Attorney General Matt Denn. “I want to recognize the efforts of Deputy Attorney General Tina Showalter and Chief Investigator Pat Corcoran of the Medicaid Fraud Control Unit for their work resulting in this arrest.”
Cermerlic was released on $112,000 unsecured bail, with conditions that he not practice medicine, or have patient contact. He was also ordered to surrender his passport.
In all cases, defendants are presumed innocent until and unless proven guilty.