FEDERAL CASE Local doctor faces charges

Dr. Martinez jumped from 153rd to first place in Ohio Medicaid transactions.
BOARDMAN -- A local physician faces charges of drug conspiracy, drug distribution, and mail, wire and health-care fraud in a 54-count federal indictment after his office was raided Thursday by FBI agents.
In conjunction with the indictment, federal agents raided the office of Dr. Jorge A. Martinez, also known as Headache and Pain Intervention Inc., at 755 Boardman-Canfield Road, after an investigation covering multiple years of Dr. Martinez's Medicaid, Medicare and workers' compensation billings.
The criminal charges are accompanied by a request from the U.S. attorney's office for a federal court injunction barring Dr. Martinez from committing federal health-care offenses, disposing of money or property derived from his alleged fraud, and discarding or altering patient or business records.
The request, filed by Assistant U.S. Attorney Lori White Laisure, also asks the court to freeze Dr. Martinez's assets, except for what a judge decides is necessary to conduct day-to-day business.
The injunction request says Dr. Martinez is being investigated for prescribing controlled substances outside the usual course of professional practice and fraudulently billing federal health-benefit programs for services he did not provide.
Jump in cases
Dr. Martinez first came to the attention of state officials in 1999 because of a large increase in his Medicaid earnings from 1998 to 1999, the document says.
In 1998, he billed Medicaid for more than $427,000 and was reimbursed more than $68,000, ranking 153rd among Medicaid doctors in Ohio. In 1999, he soared to first place among Ohio doctors, billing Medicaid for more than $2,990,000 and getting reimbursed more than $539,000.
He billed Medicaid $5,854,000 in 2000 and got paid more than $359,000, for second place among the state's physicians. In 2001, the figures were $4.9 million and $413,000, respectively, putting him in third place.
His 2002 numbers were $1.8 million in billings and $100,000 in reimbursements, and last year, the numbers were $366,000 and $71,000, respectively.
Medicaid is a federal health-care program for poor people, which is funded jointly by the federal and state governments. The document is unclear as to whether Dr. Martinez's rankings in the Medicaid program are based on his billings or his reimbursements.
The injunction request says most patients of Dr. Martinez's are covered by Medicard, Medicare, or the Ohio Bureau of Workers' Compensation.
Prescriptions at issue
According to a physician consultant, who is assisting in the investigation, "Dr. Martinez writes an aberrantly large number of prescriptions for these patients for controlled substances, including OxyContin, for which prescription costs are passed along to Ohio Medicaid and BWC for payment.''
OxyContin is a controlled substance and a controlled-release painkiller, legally available only with a valid prescription, but subject to abuse by those who defeat its time-release properties by chewing the tablets.
Dr. Martinez also bills for "an aberrantly large number of nerve blocks in comparison with his peers," according to the consultant, the document says.
In 1999, Dr. Martinez ranked first in the Medicaid program for rendering nerve block injections, with an average cost of $1,843 per patient per visit, compared with $109 for the second-ranked provider of this service. Because of the high numbers of injections he gave, Medicaid put Dr. Martinez's claims for certain nerve blocks on prepayment review in November 1999. A nerve block is the introduction of an anesthetic to prevent sensory nerve impulses from reaching the spine.
Reasons for review
The document says Dr. Martinez was placed under review because he delivered substandard medical care; he failed to establish medical necessity for treatment or individualize a treatment plan for each patient; he didn't seek help for patients from other medical professionals; and he prescribed for patients whose records document drug dependency.
The injunction request goes on to cite high billings by Dr. Martinez to the Medicare and workers' compensation programs.
Between Jan. 1, 2000, and Dec. 31, 2003, Dr. Martinez billed Medicaid, Medicare and Ohio Bureau of Workers' Compensation more than $10 million each for nerve block injections at a typical cost between $475 and $575 per injection, the document says.
Officials of the FBI and U.S. attorney's office did not return calls seeking further information Thursday evening.