Newton Doctor Found Guilty of Health Care Fraud Charges

DES MOINES, IA—On January 14, 2010, Dr. Angel Serafin Martin, MD, age 62, was found guilty on 31 counts of health care fraud at the completion of a five-day jury trial announced U.S. Attorney Nicholas A. Klinefeldt.

These charges were initiated after a patient complained to Wellmark about an explanation of benefits form indicating a visit with Dr. Martin that did not in fact occur. Wellmark began an investigation of these matters and referred it to the FBI. The FBI initiated its investigation in May 2006. In November 2006, the FBI and HHS-OIG (Health and Human Services Office of Inspector General) executed a search warrant at Dr. Martin’s Newton, Iowa clinic. This investigation disclosed that Medicare, Medicaid, Wellmark, and Principal were defrauded by this scheme.

During the trial, 27 patients testified, in addition to other witnesses, concerning office visits during the 2005 to 2007 time period. According to trial testimony, during the time period of 2004 to to 2006, Dr. Martin was one of the top billers of the highest consultation rates in the 12 state region and among the top two in Iowa. At issue was that Dr. Martin conducted office visits in Newton and Knoxville, Iowa and submitted bills to insurers private and public greater than justified by the visit. The gist of this is that he peformed a rather limited office visit, but billed it as though it were much more involved. This is sometimes referred to as “up-coding.”

Additionally, according to testimony, some of the consultations and visits were medically unnecessary under the circumstances. In one circumstance, Dr. Martin altered a medical record prior to providing it to law enforcement. Analysis showed that on 53 days in the time period 2002 to 2006, Dr. Martin billed for visits which, if performed, would have exceeded a 24-hour day. This was based upon AMA averages of physician time spent on these types of visits.

“This verdict underscores the importance of combating waste, fraud, and abuse in our health insurance system. I would like to commend everyone who brought justice to this case, from the patients who caught and reported it, to the FBI and HHS who investigated it, and to the Assistant U.S. Attorney who prosecuted it. I would also like to thank the jury for their service,” said U.S. Attorney Nicholas A. Klinefelt.

A spokesperson for Wellmark said, “On behalf of Wellmark’s members, we are pleased that the U.S. Attorney’s Office has chosen to aggressively pursue health care fraud, because fraud drives up the cost of health care for all Iowans.”

Each count of health care fraud is subject to a maximum sentence of 10 years in prison and a fine of $250,000. The court will set a sentencing date for Dr. Martin at a future date.

The United States Attorney would like to thank the FBI and Health and Human Services Office of Inspector General (HHS-OIG).