Sixth Circuit Upholds Sentencing of Anesthesiologist and Determines Health Care Fraud that Results in a Reasonably Foreseeable Death is Subject to Enhanced Criminal Penalties
Foster Swift Health Care Law Report
On December 1, 2009, the Sixth Circuit Court of Appeals upheld a jury's conviction of anesthesiologist Dr. Jorge A. Martinez for mail fraud, wire fraud, health care fraud (including two counts that resulted in the death of patients), and illegally distributing controlled substances. The Sixth Circuit also upheld the corresponding sentence of life imprisonment and over $14 million in restitution for these convictions.
Dr. Martinez operated an Ohio based pain-management clinic, in which he regularly prescribed controlled substances and administered injections for which he billed third party payors. The Federal Bureau of Investigation (FBI) began investigating Dr. Martinez for health care fraud in 2002 after discovering that his reimbursement and billing patterns for certain third party payors ranked him well above other pain-management specialists for certain procedures. Moreover, Dr. Martinez saw more patients per day than other physicians in Ohio.
The FBI investigation revealed that Dr. Martinez frequently omitted examinations, gave patients more injections than were medically necessary to enhance billing and increase patient dependency, and frequently billed patients for longer visits than they actually received. For these behaviors, Dr. Martinez was convicted of health care fraud under the federal health care fraud statute.
Two of Dr. Martinez's patients died as a result of these fraudulent behaviors. The federal health care fraud statute provides an enhanced prison sentence, including life imprisonment, for health care fraud violations that result in death. The extent of causation required to be liable for an enhanced prison sentence for violations that result in death under the statute had not been determined by the Sixth Circuit prior to this case.
Here, the Sixth Circuit specifically determined that where the death of a patient is a proximate cause, or the natural and foreseeable result, of a physician's fraudulent scheme the physician may be held criminally liable, and subject to enhanced sentencing. Thus, if the death is a foreseeable result of a fraudulent health care scheme, a term of life imprisonment is a potential consequence.
The Sixth Circuit held that the two patients' deaths related to Dr. Martinez's practice were a reasonably foreseeable consequence of Dr. Martinez's continued fraudulent treatment. Specifically, Dr. Martinez ignored obvious "red flags" that the patients were addicted to narcotics and he continued to prescribe medically unnecessary and harmful injections. Dr. Martinez was, therefore, convicted of health care fraud violations that resulted in death and was sentenced to life imprisonment. Thus, not only can a single treatment or dose that results in a patients death be prosecuted under the federal statute, but prolonged fraudulent treatments that result in death are also punishable and subject to the enhanced sentencing.
Lastly, the Sixth Circuit court determined that the $14 million in restitution was properly calculated. The restitution was calculated was based on the entire scheme of the fraudulent behavior from January 1998 to September 2004 and not just the specific charges brought against Dr. Martinez. Therefore, the penalties for health care fraud are expansive and expensive and include not only all intended results of the fraud but foreseeable consequences. United States v. Martinez, Nos. 06-3882/4206 (6th Cir. Dec. 1, 2009).