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Health care fraud trial continues
Published September 17, 2009
QUOTE: In September 2007 Robert Rael (a third defendant in the case) signed a statement alleging the three filed at least 49,418 claims with Medicare and Medicaid seeking payment for services not rendered between January 2002 and September 2005.
Paperwork. That was the focus during the second day of testimony in a trail against a local psychiatrist alleging health care fraud, conspiracy and money laundering.
Billing statements, time sheets, applications and IRS documents were all entered into evidence Wednesday as part of the government's case against Dr. Rafael Solis and his co-defendant Sylvia Delgado.
Solis, a psychiatrist, and Delgado, reportedly a billing clerk, are accused of defrauding the government of approximately $3 million during the three-year span Synergy Counseling was operating in Del Rio.
While Synergy was supposed to provide services to the elderly in need of psychiatric treatment, an indictment against the pair alleges they billed for psychotherapy session “when in fact the actual service provided to clients included being read the Bible and local newspaper, eating, watching television, and playing loteria”.
That indictment was handed down in 2007 after a multi-agency investigation into operations at Synergy.
The Internal Revenue Service, Health and Human Services, Office of the Inspector General and Medicaid Fraud Control Unit all participated in the investigation.
Starting the string of witnesses testifying in U.S. District Judge Alia Moses Ludlum's federal court Wednesday was Christine Griffith, an employee of TrailBlazer, a private contractor that processes Medicare claims.
Griffith testified about billing statements submitted for payment to Solis and that he had signed several applications over the years to receive Medicare compensation stating he bore sole responsibility for ensuring the accuracy of claims submitted for payment.
The government has maintained that Solis was unable to bill for psychiatric group therapy, in part, because he was often not present when those sessions took place.
Griffith testified that bills for psychotherapy session couldn't be paid unless a psychiatrist is either providing those services or is on-site to oversee the treatments.
She also testified to a telephone conversation between TrailBlazer's customer service department and a woman identified as “Sylvia D.” on July 22, 2005.
During that conversation Delgado reportedly sought information on whether she could bill for psychiatric services provided by a Licensed Master Social Worker.
A third defendant in the indictment, Robert Rael, is listed as a Licensed Master Social Worker and is reported as the person providing group therapy at Synergy.
Rael has pleaded guilty to his role in the case and is set to testify against Solis and Delgado.
Upon cross examination by Solis' attorney James Deegear III, Griffith maintained that a psychiatrist must be present when services are rendered despite Deegear's attempts to force her opinion otherwise.
A manual for doctors entered into evidence states that the psychiatrist must be present to provide assistance “if necessary”.
Deegear repeatedly questioned whether Solis had to be present based on the “if necessary” wording. He also pointed out the policy is not law, but rather guidelines created by TrailBlazer, not Medicare.
“You must be present in the office suite, that's clear,” said Griffith. “He has to be present to bill for service.”
Deegear then asked if Griffith had any evidence indicating Solis “knowingly and willfully” falsified claims to Medicare.
“I believe that is why we are here, sir, to determine that,” replied Griffith.
When Deegear continued pushing Griffith, Ludlum intervened.
“You are asking her to provide an opinion on an issue the jury should decide,” said Ludlum. “Rephrase (your question).”
With that, Deegear ended his cross-examination.
Next to take the stand was James Marr, who handles business operations for GEO Group.
Marr testified that Solis was contracted to provide psychiatric evaluations when the company, which owns and operates criminal detention centers across Texas, needed to certify jailers with the state licensing office.
Marr testified to the company's employee time documents, specifically those of Solis which noted when the psychiatrist provided services at facilities for Karnes City, Del Rio and San Antonio.
Dates noted on those documents indicate Solis billed GEO for providing psychiatric evaluations on the same day services were billed to Medicare through Synergy for services rendered there.
Sam Bayless, who is also representing Solis, questioned whether the time documents left room for human error, noting that Solis was not required to punch in on a time clock.
Marr agreed the time records were maintained by staff and could be subject to human error.
Next the government introduced Primitivo Molina, who works with the Department of Assisted and Rehabilitation Services to recruit physicians to conduct evaluations of persons seeking Social Security benefits.
Molina said Solis was part of a panel in Del Rio and San Antonio to conduct evaluations and that he knew Delgado to be Solis' “secretary”.
Molina then identified a number of IRS tax forms showing what was paid to Solis for his services each year from 2002 to 2005, and reviewed an appointment log kept by the agency showing dates when Solis met with clients.
One date noted on that record, Sept. 14, 2004, coincides with a date a bill was submitted to Medicare through Synergy for services rendered at that location.
Upon cross-examination from Bayless, Molina also noted the room for human error on the document, but said it was unlikely Solis missed his appointments without the agency knowing.
Molina testified that the agency calls the day after an appointment to ensure it was kept, and that clients will report a physician who doesn't show because they could risk losing benefits if those appointments are not kept.
Wednesday's portion of the trial closed with testimony from Sharon Thompson, an employee of the Texas Health and Human Services Commission who is set to testify to Medicaid documents.
Thompson testified to the authenticity of applications filed by Solis to the agency for billing privileges in 1998, 1999 and 2000. On each Thompson testified that Solis signed his name below statements certifying he had read the application and understood its contents including those related to fraudulent charges and that he held the responsibility for ensure claims submitted under his Medicaid identification number were accurate, regardless of who billed them.
Testimony in the case ended at 8 p.m. and will continue today.
John Carroll, the attorney for Delgado has maintained his client was merely a billing agent whose company, MedCorp, was contracted by Solis to handle his accounts.
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