JAY GREENE February 21, 2020 12:29 PM
Anthony Vespa,
the former executive director of Southeast Michigan Accountable Care in
Dearborn, was sentenced Wednesday to three years in federal prison after
pleading guilty to wire fraud in connection with the theft of more than $3.4
million from the Medicare accountable care organization, according to U.S.
Attorney Matthew Schneider in Detroit.
SEMAC, which was
affiliated with United Outstanding Physicians of Dearborn, a 1,000-member
physician organization founded in 2002 by Yasser Hammoud, M.D., appears to have
shut down ACO operations either in 2017 or 2018, according to data provided by
the Centers for Medicare and Medicaid Services. Founded in 2012, SEMAC was not
listed as an active ACO in 2018 by CMS.
"Unfortunately
due to current litigation against individuals/entities that received some of
the monies that Mr. Vespa misappropriated, I cannot comment about SEMAC
operations," said Ben Gonek, an attorney representing SEMAC with Ben Gonek
Law, PC in Southgate. He declined further comment about ongoing efforts to
recover additional funds.
Gonek told
Crain's that SEMAC uncovered the missing money during an audit in September
2017, a month after Vespa was terminated from the company.
After Vespa, 55,
left the ACO, he opened a new account for SEMAC, unknown by the organization,
by which Medicare transferred 2016 shared savings bonus funds to Vespa's
account, according to a news release from Schneider's office. He wrote checks,
transferred money out of the account and used most of the funds for his own
benefit, Schneider said.
Gonek said SEMAC
reported the theft to the FBI and U.S. Department of Justice and sued Vespa for
the missing funds. He said SEMAC has recovered a "substantial amount"
of the missing money, but that some money is still unrecovered.
"The physicians
of SEMAC are grateful to the United States Attorneys Office and the FBI for the
outstanding job that they did in investigating this matter, prosecuting Mr.
Vespa, and (assisting in) recovering some of the monies Vespa
misappropriated," Gonek said in a statement to Crain's.
Medicare ACOs are
groups of doctors, hospitals and other health care providers who come together
voluntarily to provide coordinated high-quality care to Medicare patients. The
goal of coordinated care is to ensure that patients, especially the chronically
ill, get the right care at the right time, while avoiding unnecessary
duplication of services and preventing medical errors.
ACOs share in
savings by meeting a quality performance standard and saving at a rate equal to
or greater than a minimum benchmark. Total earned shared savings are adjusted
for quality performance.
"Medicare's
shared savings program is intended to promote the effective delivery of medical
services by rewarding physicians who provide excellent patient care in the most
efficient way possible," Schneider said in a statement. "The public
has a right to trust that the tax dollars they pay to support Medicare programs
are used for their intended purpose. This prosecution serves as a warning that
we will relentlessly pursue anyone who steals Medicare funds for their own
personal use."
FBI Special Agent
in Charge Steven D'Antuono said that even after Vespa's scheme was discovered
he continued to take money, "which makes it even more reprehensible."
Following his
release from prison, Vespa will serve a two-year term of supervised release and
was ordered to pay restitution and forfeiture in the amount of $3.45 million
for the money he stole from SEMAC.
Michigan big with
ACOs
In 2018,
Michigan's 20 accountable care organizations earned back nearly $97.5 million
compared with $72 million in 2017, Crain's reported last year.
Overall, Michigan's ACOs saved Medicare a total of $214.9 million in 2018, up
from $181.6 million in 2017.
Under incentives
provided by the Affordable Care Act, hospitals and doctors have been working
together the past eight years to reduce costs and improve quality for nearly 12
million traditional Medicare patients.
Over at least
five years, SEMAC generated millions of dollars in savings for Medicare and
most years retained enough savings to keep a portion for its participating
doctors while at the same time hitting quality scores of 90 percent or higher.
For example, in
its first 18-month period from July 2012 to December 2013, SEMAC saved $24.6
million and kept $12.1 million during the same period. In 2016, SEMAC generated
shared savings of $3.95 million, which was paid on Oct. 23, 2017. Most of the
money was taken by Vespa in this payment.
This article was originally
published in Crain's Detroit Business.
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