|
Health care fraud trial begins
Published September 16, 2009
A trial involving alleged health care fraud, money laundering and conspiracy centered on Synergy Counseling is underway in federal court.
The defendants, Dr. Rafael Solis, a psychiatrist, and Sylvia Delgado, are accused of defrauding the government of approximately $3 million during a three-year span.
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 sessions “when in fact the actual service provided to clients included being read the Bible and local newspaper, eating, watching television, and playing loteria”.
A third defendant in the trial, Robert Rael, has pleaded guilty and is set to testify against Solis and Delgado. In a statement signed by Rael in September 2007, he alleges the three filed at least 49,418 claims with Medicare and Medicaid seeking payment for services not rendered between January 2002 and September 2005.
Attorneys outlined their cases during opening statements in U.S. District Judge Alia Moses Ludlum's federal courtroom Tuesday afternoon.
Attorney Kimberly Johnson provided opening statements for the government.
“Greed, that's what this case is about,” said Johnson, who said Medicaid and Medicare would have paid for the “adult daycare” services Solis and Delgado were providing, but not nearly as much as what was paid by claiming psychiatric services were rendered.
Not only were the pair billing for psychiatric services not provided, Johnson said they repeatedly billed for the services, in some cases claiming one patient received seven psychotherapy sessions in a single day.
What's more, Johnson said, none of the three indicted were providing what limited services were offered.
A fourth party, Roberto Martinez, who is not included in the indictment, was a Synergy van driver and cook. Martinez, Johnson claims, is the person who spent time with the patients during their “psychotherapy sessions”.
Johnson said even after two agencies questioned bills submitted to the government requesting compensation in July and October of 2004, Solis and Delgado continued the practice.
“They didn't stop the gravy train until Medicare shut them down,” Johnson told the jury.
Attorney John Carroll provided opening remarks in defense of Delgado, claiming she was merely the billing agent.
He said the working relationship between Delgado, who operated a private medical billing business, and Solis spans years before Synergy was formed, when the psychiatrist used Delgado's business to handle his accounts.
Carroll said when Synergy opened, it was “only natural” Delgado would handle those accounts as well.
Solis or Rael would fill out the paperwork, complete with billing codes, and submit that information to Delgado for her to file the claims with the government, said Carroll.
“She was given (paperwork) saying (Rael) did the sessions. She's not a psychiatrist, she's not a psychologist, she's not a social worker, she was a biller,” said Carroll, who noted while Delgado's business and Synergy shared space in the same strip of offices at 104 Fletcher Drive, they were not directly linked.
As for Rael's testimony against Delgado, Carroll said there is a history of tension between the pair because Rael thought Delgado was overpaid for her services.
“You'll hear about hostility between Sylvia Delgado and Robert Rael,” said Carroll. “There was conflict. They didn't get along.”
Carroll also said Delgado didn't provide false statements to the government during the course of the investigation as earlier alleged by Johnson in her opening remarks.
According to court paperwork, Delgado told investigators “Dr. Solis supervises the group sessions as his office is within the premises of the group therapy sessions held”.
The billing of psychotherapy sessions cannot be paid unless a psychiatrist is either providing those services or is on-site to oversee the treatments, according to testimony in the case from Christine Griffith, who works for a contractor that processes Medicare claims.
Johnson says Solis was rarely on-site and that Delgado knew this, but told investigators he was overseeing the operation.
Carroll says Delgado's statement is not false because Solis was the psychiatrist running the office.
“She told (investigators) the truth as she knew it,” said Carroll.
Solis’ attorney had not provided an opening statement as of 6:30 p.m. Tuesday.
Testimony in this case continues today and is expected to span several days.
Share |
Save |
Mail |
Print
|
