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Evidence keyed to Fisher
United States v. Semrau
Citation:
693 F.3d 510 (6th Cir. 2012)Facts
Dr. Lorne Semrau owned Superior Life Care Services, Inc. and Foundation Life Care Services, LLC, which provided psychiatric follow-up care to nursing home patients in Tennessee and Mississippi. These companies contracted with psychiatrists who submitted records describing their services, which Dr. Semrau’s companies then billed to Medicare and Medicaid through private insurance carriers. Dr. Roy Barnes, one contracting psychiatrist, typically spent six to eight minutes per patient performing standard evaluations and consistently indicated CPT code 90862 on his log sheets. After a 2002 CIGNA audit found Superior had been upcoding services, and following a 2003 Medicare reimbursement rate reduction for code 90862, Dr. Semrau instructed his billing staff to bill nearly all services indicated as 90862 at the higher-paying code 99312, despite the documented services not meeting the requirements for that code. This practice continued until four days after a grand jury subpoena was served in December 2004. To support his defense that he lacked intent to defraud and acted in good faith, Dr. Semrau underwent fMRI lie detection testing with Dr. Steven Laken of Cephos Corporation, producing results indicating he was “not deceptive” regarding the upcoding charges, though an initial test on separate charges showed deception before a retest showed truthfulness.
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