On December 11, 2009, an 88-year old audiologist Adam John Sotrini was sentenced by United States District Judge Oliver W. Wanger, to six months in prison to be followed by 15 months of home confinement, plus restitution of $100,000, for his scheme to defraud the Medicare program by submitting false billings for audiology services.
A jury found him guilty of 17 counts of mail fraud and one count of health care fraud on November 4, 2008. According to the Assistant United States Attorneys who prosecuted the case, the evidence introduced at trial showed that Mr. Sortini visited skilled nursing facilities throughout Northern California and billed for hearing tests that were not reimbursable by Medicare because they were routine in nature and were performed without a referring physician’s order.
It was contended at trial that Mr. Sortini also did not perform all of the tests for which he billed Medicare, and when he was audited by Medicare, he submitted forged physician referrals to justify his Medicare billings. The government presented evidence at trial that Mr. Sortini billed Medicare for unwarranted and unnecessary hearing tests, including tests for patients with severe mental deterioration including Alzheimer’s disease, dementia, and senility, and claimed on certain days to have tested between 25 and 50 or more patients at skilled nursing facilities located more than 100 miles apart.
Mr. Sortini billed and was paid hundreds of thousands of dollars for these services. This continued from January 1998 to January 2003, when the FBI conducted a search warrant at his office in Merced.
Mr. Sortini testified at trial which, based on the judge's comments at sentencing, was in hindsight a mistake. At sentencing, Judge Wanger found that Mr. Sortini had obstructed justice by committing perjury at trial, had abused the trust of the Medicare program, and had taken advantage of vulnerable, elderly victims, many of whom were mentally incompetent. The judge took into account Mr. Sortini’s age and medical condition, but determined that a prison sentence was warranted given the nature of the defendant’s fraud.
Attorney Commentary: This case illustrates why there are so many plea bargains in the federal court system. With this loss amount, a prison sentence normally would have been unlikely. However, when a trial is lost by a criminal defendant -- prison term is the likely outcome. In addition, when the trial is lost and the defendant has testified -- the judge has the discretion to say that he did not believe the defendant's testimony and increase his or her sentence for obstruction of justice.
There has been significant fraud and abuse in the Los Angeles area for audiology. However, medical necessity is not usually the stuff of federal health care fraud cases. In this case, the forging of records helped establish fraud.
It is also not uncommon for elderly doctors and health care providers to be taken advantage of by entrepreneurs in the health care business. It is quite unusual for someone of the age of 88 to be sentenced to prison but the judge's comments reflect his outrage. The climate in federal sentencing does not favor health care fraud defendants especially when the health care system and federal and state budgets are in a crisis. Sentencing in federal court is practically a separate trial in itself since it is vastly different than state court sentencing.
Posted by Tracy Green. Should you have any questions regarding your own situation or this post, you can email Tracy at email@example.com. Green & Associates in Los Angeles, California focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers. Their website is: http://www.greenassoc.com/