Local Doctor pleads guilty and agrees to pay $5 million for
submitting false claims to Medicaid and other insurers

  Washington, D.C. - A local physician, Martin R. McLaren, has pleaded guilty to making a false statement in relation to health care matters and agreed to pay $5 million in restitution and forfeiture, U.S. Attorney Jeffrey A. Taylor, Joseph Persichini, Jr., Assistant Director in Charge of the FBI’s Washington Field Office, Patrick Doyle, Special Agent in Charge of the Health and Human Service - Office of the Inspector General, Patrick McFarland, Inspector General of the Office of Personnel Management, and U.S. Department of Labor Inspector General Gordon S. Heddell announced today.

McLaren, 65, of Thornden Terrace, Bethesda, Maryland, entered his guilty plea yesterday before U.S. District Judge Colleen Kollar-Kotelly. At the sentencing, which has been scheduled for July 11, 2008, McLaren will face a maximum sentence of 46 months of incarceration. As part of the plea, McLaren agreed to forfeit property and pay cash totaling approximately $5 million to settle criminal restitution, forfeiture, and civil aspects of the case.

Dr. McLaren stipulated that he had caused $1.75 million in loss because of his actions at the Pain Management Clinic. Dr. McLaren is an anesthesiologist who owns the Pain Management Center, which was located in Hyattsville, Maryland, and rented space at other locations, including Waldorf, Oxon Hill and Largo, Maryland.

In his billing procedures, between 2000 and 2006, Dr. McLaren used a pre-printed form, known in the medical industry as a “superbill,” to indicate which medical procedures or services should be billed for each individual patient. The superbill listed the names of procedures that Dr. McLaren commonly billed, and also listed the corresponding code for each procedure. The procedure codes, also known as “CPT codes,” are defined in the American Medical Association Physician’s Current Procedure Terminology (“CPT”) Guidebook.

To initiate the billing process for an individual patient, Dr. McLaren would circle procedure codes on the superbill to indicate which procedures should be billed to the patient or to the
patient’s insurance company. Upon receiving the superbill, the billing employee would enter information from the superbill into a billing software program, which, in turn, would generate an insurance claim form, known in the industry as a HCFA or CMS 1500 claim form. Dr. McLaren was required to certify on the claim form that all of the information on the form was accurate. Once the claim form was prepared, Dr. McLaren’s staff submitted the form on his behalf by mail or electronically to Medicaid, Medicare or to the appropriate private insurance company for processing and payment. The insurance provider based the payment amount on the CPT codes specified on the claim form.

Dr. McLaren, with the assistance of his staff, submitted claims for payment to Medicaid, Medicare, private insurance companies and employee benefit plans such as Aetna, Inc., CareFirst Blue Cross Blue Shield, and Liberty Mutual, Inc., the Federal Employees Health Benefits Program, the Maryland Injured Worker’s Insurance Fund and the U.S. Department of Labor’s Office of Worker’s Compensation Programs.

Specifically, with the assistance of his staff, Dr. McLaren submitted several claims to health benefit programs to seek payment for transforanimal epidural injections (CPT Codes 64479, 64483 and 64484). Transforanimal epidural injections, or “TEI,” are essentially complex injections made around the spinal area for the purpose of pain relief, and require specialized equipment, including flouroscopic image guidance and 3.5 inch long needles. Dr. McLaren admitted that he did not actually perform TEI as part of his medical practice.

In announcing the guilty plea, U.S. Attorney Taylor, FBI Assistant Director in Charge Persichini, HHS-OIG Special Agent in Charge Doyle, OPM Inspector General McFarland, and DOL Inspector General Heddell praised the joint investigative efforts of the FBI Health Fraud Squad, HHS-OIG Special Agent Robert Slease, OPM-OIG Special Agent Christopher M. Gleason, and DOL-OIG Special Agent Edgardo Correa. They also commended Assistant U.S. Attorneys Diane Lucas and William Cowden of the Asset Forfeiture Unit, Assistant U.S. Attorney Laurie Weinstein of the Civil Division, and former Assistant U.S. Attorney Glen Donath and Assistant U.S. Attorneys Geoffrey Carter and Thomas E. Zeno as well as Legal Assistant Lisa Robinson of the Fraud and Public Corruption Section.