Dover doctor charged with health care fraud

Following an investigation by the Department of Justice, officials in Delaware say Dr. Senad Cemerlic, an anesthesiologist and owner of ABG Pain Clinic in Dover, was arrested on six counts of felony health care fraud last Tuesday, September 22.

Dr. Cemerlic was investigated by the DOJ Medical Fraud Control Unit, after receiving a hotline tip that various potential billing schemes were occurring at the ABG Pain Clinic.

According to officials, an investigation was conducted into Dr. Cemerlic’s billing practices for patient in-office testing, examinations and treatment allegedly provided at the clinic. That investigation led to a discovery of billing schemes from November 2012 until September 2013.

Investigators say the alleged fraud by Dr. Cemerlic includes billing to services he never provided to patients, submitting claims to the Delaware Medicaid program, as well as to Medicare and third-party private insurers,
for services and testing that were not necessary for patients, as well as billing for tests and equipment provided by an outside lab, and “upcoding,” which means submitting claims for procedures and tests with higher reinbursement codes than what was actually performed.

“Fraudulent billing for services not rendered is one of the factors in health care costs being too high, and finding and prosecuting cases of Medicaid fraud is one of the key priorities I have set for our office,” said Attorney General Matt Denn. “I want to recognize the efforts of Deputy Attorney General Tina Showalter and Chief Investigator Pat Corcoran of the Medicaid Fraud Control Unit for their work resulting in this arrest.”

Dr. Cermerlic was reportedly released on $112,000 unsecured bail. 

Officials say he is not to practice medicine or have patient contact.

Officials remind readers that all cases, defendants are presumed innocent until and unless proven guilty.