$830K Returned to Ohio Workers’ Comp Bureau After Fraud Conviction

The Ohio Bureau of Workers’ Compensation (BWC) has received a record $830,000 in restitution from an Akron area anesthesiologist five years after his conviction in an insurance fraud case that captured national attention and sent him to prison for life.

The BWC said Dr. Jorge Martinez was convicted in 2006 on 56 criminal counts stemming from a wide reaching health care fraud investigation that was featured on CNBC’s American Greed. Officials said he submitted $60 million in fraudulent claims to BWC, Medicare, Medicaid and private insurers.

The case resulted in the first known conviction involving a criminal charge of health care fraud resulting in death after the overdose of two patients seeking treatment for work-related injuries.

An investigation of Martinez began after questions arose about his billing practices and his ranking above all other Ohio medical practitioners in the number of claims submitted for reimbursement. The inquiry revealed a scheme that permitted Martinez to bill patients’ insurance companies for unnecessary prescriptions and injections to treat pain.

Martinez often saw more than 100 patients a day and provided them with narcotics prescriptions only after requiring them to undergo expensive nerve block injections. Evidence presented by BWC showed Martinez averaged 64 injections per patient each year, far above the state average of 2.5 injections per year. Martinez also billed insurance companies for prescriptions never written.

In June 2006 Martinez was convicted on 56 counts that included distribution of controlled substances, mail fraud, wire fraud and health care fraud. The jury also found Martinez guilty of health care fraud resulting in death after determining that he contributed to the deaths of two Ohioans receiving treatment for work related injuries. One patient died the same day he received a prescription from Martinez; the other collapsed in his office and died soon after.

The joint investigation included BWC, the Ohio Department of Job and Family Services, the Drug Enforcement Administration and several private insurers.

Martinez still owes BWC $5 million.

Source: Ohio BWC