PRACTICE AREA(S): General Litigation, White Collar Defense and Investigations
CLIENT / INDUSTRY: United States Government
ATTORNEY(S): Virginia Davidson
Situation Summary:
Calfee partner Virginia Davidson, a former Assistant U.S. Attorney, prosecuted this case on behalf of the United States. The government charged that Jorge A. Martinez, M.D., defrauded the Ohio Bureau of Workers Compensation, Medicare, Medicaid and private insurance companies of $60 million, and received more than $12 million from the scheme. Martinez ran pain management clinics. He gave his patients – often more than 100 per day – the same regimen of injections and narcotic pills.
By demanding that patients see him weekly, Martinez rendered them physically dependent and/or addicted to the drugs he prescribed. If a patient refused injections, Martinez withheld the pills. He then billed their insurance companies thousands of dollars for visits that lasted a few minutes. The injections were crude and medically useless numbing procedures, sometimes involving steroids without the patient’s knowledge. But Martinez billed the insurance companies thousands of dollars per visit as if he had performed multiple, complex epidural and nerve block procedures more commonly done in a hospital out-patient setting. Martinez also insisted that patients “donate” cash for his malpractice costs.
Approach:
The case required analysis of millions of patient records accumulated over six years, as well as voluminous data from multiple insurers. The government determined to use statistically valid random sampling, combined with medical expert review and testimony, to reduce the amount of evidence that it needed to gather and present. Statistical sampling is equally useful in the defense and investigation fraud matters.
Martinez’s falsified patient files made it difficult to prove that his insurance claims were false. Patients, who relied on Martinez for their drugs, were reluctant to testify against him, as were his employees, who feared him. The government was able to obtain and present undercover video of patient visits, and to contrast that evidence with demonstrations of actual nerve blocks and epidurals, and expert testimony regarding the difference between those procedures and Martinez’s activities. That, combined with careful examination of patient and employee witnesses, painted an accurate picture of the scheme.
Resolution:
This case was investigated by the Federal Bureau of Investigation and the United States Department of Health and Human Services, Office of Inspector General, Office of Investigations, with help from the Drug Enforcement Administration.
A federal jury returned guilty verdicts against Martinez after a five-week trial. They found that as a result of the illegal scheme, Martinez caused the deaths of two men who died while in Martinez’s care. Martinez was convicted of mail fraud, wire fraud, health care fraud, drug trafficking, and two counts of health care fraud resulting in death, the first such conviction in the country.
A judge sentenced Martinez to a term of imprisonment that included life in prison without possibility of parole on both counts of health care resulting in death, and on the remaining fraud counts. In considering the amount of dollar loss resulting from the fraud counts, the judge commented that the government’s statistical proof was the most important evidence in the case.
This case demonstrates the depth of experience Calfee litigators bring to the defense of complex financial matters. Gina’s courtroom experience and ability to digest and synthesize large amounts of data into a meaningful presentation that a jury could understand were key in winning the case.
The results described in each case study are dependent on the specific factual and legal circumstances of the matter described, and constitute neither legal advice nor a guarantee of similar results with respect to any other matter.