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.

Delaware Medicaid Program to receive more than $573,000

Attorney General Matt Denn announced that Delaware settled kickback claims against Accredo Health Group, Inc. (“Accredo”). The settlement resolves allegations that Accredo recommended the drug Exjade to Medicaid patients in exchange for kickbacks from Novartis Pharmaceuticals Corporation (“Novartis”), which markets the drug. Under the settlement, Accredo has agreed to pay $60 million to the United States and over forty states. Delaware will receive $573,314.94 under the settlement. The money will be returned to the state’s Medicaid system.

Accredo, a specialty pharmacy headquartered in Memphis, Tennessee and a wholly owned subsidiary of Medco Health Solutions, Inc., ships prescription drugs to Medicaid patients around the country. Exjade was approved by the U.S. Food and Drug Administration in late 2005 for the treatment of chronic iron overload due to blood transfusions. In complaints filed in the case, several states and the federal government have alleged that Novartis developed the scheme because Exjade patients often stopped taking the drug because of side effects. The settlement resolves allegations that Accredo participated in a scheme in which Novartis paid kickbacks to pharmacies by giving more prescription referrals to the pharmacy that kept patients on Exjade the longest.

The settlement stems from a whistleblower lawsuit, U.S. ex rel. Kester, et al. v. Novartis Pharmaceuticals Corporation, et al., No. 11-CIV-8196, which is pending in federal court in New York. The case was filed under the federal False Claims Act and similar state false claims acts.

The state settlements were negotiated by a team of states led by representatives from the Offices of the Attorneys General for California and New York.