Detelich photo

Brent J. Detelich

Two witnesses in Brent J. Detelich’s federal criminal trial in Pittsburgh have testified that they are sure there was wrongdoing going on in the office.

What they often were not sure of was when that wrongdoing occurred.

The timing is important for the defense because Detelich’s attorney is claiming the government went beyond the five-year statute of limitations in getting an indictment.

Detelich, 37, of Clearwater, Fla., is facing charges of health care and mail fraud that occurred at the former Detelich Chiropractic and the former Advanced Medical and Holistic, both in Hermitage.

One of the aspects of the charge of health care fraud was that the companies billed Highmark Inc. for services beyond what treatment actually was performed, a practice known as upcoding. Danielle Fender, who was hired by Detelich’s father, James Detelich, in 1995 and stayed with it and Advanced Medical until Advanced Medical closed in 2002, said office forms at one point contained only one option for billing, S8905, which brought the most money into the business, $250 a visit.

Donald K. Proper, who returned to the witness box Tuesday for a second day, said the staff underwent training in May 2000 with Michael Miscoe, a certified coding professional, and stopped billing S8905. Miscoe believed that no chiropractor should be billing that code, said Proper, a chiropractor and office manager with Advanced Medical.

Proper said S8905 required at least 60 minutes of treatment. “You had to examine certain areas of the body and meet certain requirements,” Proper said.

Detelich’s attorney, Robert J. Ridge, showed Proper Highmark documents that made no mention of a time limit for billing S8905. Proper also testified that he never recalled Highmark turning down an S8905 claim.

Prior to Miscoe’s training, Proper came to understand the billing procedure better and determined the office should not be billing S8905s. He approached Detelich about it.

“His responses were: it was his clinic, if I don’t like it I can go somewhere else,” Proper said.

Concerning charges that Highmark was billed for patients who never received services, Proper said his mother-in-law, Joyce Ofredo, was one of them. She had gone to the clinic once or twice, but the billings continued.

“It was billed for services she didn’t receive,” Proper said of Ms. Ofredo’s insurance company.

Ms. Fender, of Shenango Township, is a key witness for both sides because she has pleaded guilty to health care fraud as part of the probe of Advanced Medical, and has not been sentenced pending her testimony. She acknowledged billing for services that were not performed and splitting insurance proceeds 50-50 with Detelich. She said the total Highmark was defrauded was $25,000, while her plea agreement specifies less than $30,000.

Ms. Fender became a name on the “hit list,” a list of patients whose insurance was billed up to three times a week whether they had been to the clinic or not.

“It was automatic,” she told Assistant U.S. Attorney Shaun E. Sweeney. “Monday, Wednesday, Friday, you pulled their treatment cards.”

Ms. Fender didn’t recall any specific orders or conversations about generating bills from the hit list, but it eventually was put in writing and kept at the front desk.

“We all kind of knew they were just being billed,” she said.

Ridge asked Ms. Fender how she knew the patients had not been treated.

“Common sense,” she said, adding that the practice continued after Detelich moved to California.

The practice eventually stopped, but Ms. Fender did not definitively say when.

Detelich started splitting fees with Ms. Fender when she was single and was talking about leaving Advanced Medical because she could not afford health insurance. Detelich also chipped in when she married Wade Plymire — they have since divorced — and he switched jobs. She needed extra money to continue her health care, although Plymire went back to his old job after only three months, she said.

Ms. Fender explained that she would have the insurance checks in her name or her husband’s name sent to her home. She would cash them and give Detelich half, she said.

Ms. Fender’s mother, Dorothey “Dottie” Fender, also was on the hit list, and shared money with Detelich, Danielle Fender said.

Dorothey Fender, who also is set to testify, has pleaded guilty to health care fraud.

With Proper on the stand, Ridge started trying to undermine Ms. Fender’s credibility. Although Proper said he did not recall any complaints about Ms. Fender, he acknowledged an office document that said staff members had complained about her attitude and tone in conversation, and that she tried to make changes without supervisory approval.

“The best I can remember, we had some personality problems in the office,” he said.

Ms. Fender was docked five hours’ pay for improperly filling out a time card, and Proper also recalled that Ms. Fender was moved out of the office and worked from Detelich’s home in Clark for a while.

Ms. Fender also expressed some concern for her job and appeared unwilling to cooperate too much with other staff members out of fear of rendering her services obsolete.

“I was always worried about my job,” she said.

Ridge showed Ms. Fender had a faulty memory about many things, although it will be up to the jury to decide the relevance of what she could not remember.

She did not recall telling the FBI she had been with Detelich Chiropractic/Advanced Medical for nine years as of 2002, while Tuesday she said she started in 1995. She did not remember that her title had once been insurance manager, although she acknowledged that she identified herself as such on a company document. She agreed she had been disciplined at the company, but did not remember what for.

Concerning office policies penned by Proper, she said she had no understanding of key Scientology concepts named in them such as ethics, out ethics and counter intention. Even though she worked in billing, she said she had no understanding of basic accounting principles such as accounts receivable.

She even said she did not know what a court motion was — a lawyer’s request for a judge’s decision in a case — even though her plea agreement, which she said she had read, said the U.S. Attorney’s Office has the right to file a motion asking that her sentence be reduced below sentencing guidelines for her cooperation.

Ridge became livid when asking Ms. Fender about her plea agreement. He asked what was expected of her in return for her plea.

“We didn’t agree to anything,” she said.

Even though the agreement gives the government discretion to advise the judge as to the value and level of her involvement and to ask the judge to sentence her below sentencing guidelines, Ms. Fender said she had only one reason for pleading guilty:

“I agreed to plead guilty because I was guilty,” she said.

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