United States v. Lorne Semrau
2012 U.S. App. LEXIS 18824
| 6th Cir. | 2012Background
- Dr. Semrau was convicted of three counts of healthcare fraud under 18 U.S.C. § 1347.
- He ran Superior Life Care Services, Inc. and Foundation Life Care Services, LLC, which contracted psychiatrists to provide care to nursing home patients and billed Medicare/Medicaid/CAHABA and CIGNA.
- Providers logged patient care using CPT codes; discrepancies between codes 90862 and 99312 affected reimbursement.
- CIGNA audit in 2002 found overbilling at 90862; Superior began billing 99312 in some states, increasing payments in Mississippi where no audit occurred.
- Dr. Semrau sought to introduce fMRI lie-detection evidence to show his good faith, but the district court excluded it; jury convicted on the charged healthcare-fraud counts.
- On appeal, the court affirmed the conviction, addressing admissibility of the fMRI evidence and other challenged issues.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of fMRI lie-detection evidence under Rule 702 | Semrau argues fMRI is admissible as reliable, probative fraud evidence. | Semrau argues fMRI is scientifically unreliable and should be admitted to show intent. | District court did not abuse discretion; fMRI testimony excluded under Rule 702/403. |
| Rule 403 analysis of fMRI evidence | fMRI evidence is highly probative of credibility and not unduly prejudicial. | fMRI evidence is highly prejudicial and could mislead jurors about credibility. | Court affirmed exclusion under Rule 403. |
| Sufficiency of the evidence to convict on healthcare fraud | Evidence shows Semrau caused fraudulent claims by upcoding to higher reimbursements. | Codes were arguably interchangeable or applied in good faith. | Evidence sufficient; a rational jury could find intent to defraud. |
| Jury instructions on good-faith/interpretive questions | Instructions should have allowed acquittal if billing was objectively reasonable or interpretively disputed. | Existing pattern instructions adequately conveyed good-faith defenses. | No reversible error; district court’s instruction was sufficient. |
| Motion to compel production of toll-free call records and GAO reports | Records would corroborate discussions with carrier support lines; GAO reports show miscommunication. | Records unlikely to be material; GAO reports excluded as irrelevant or confusing. | District court did not abuse discretion; records and GAO reports not material or overly prejudicial. |
Key Cases Cited
- Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (Supreme Court 1993) (establishes gatekeeping standard for admissibility of expert evidence)
- United States v. Bonds, 12 F.3d 540 (4th Cir. 1993) (Daubert factors; admissibility of new forensic evidence)
- Best v. Lowe’s Home Centers, Inc., 563 F.3d 171 (6th Cir. 2009) (applies Daubert factors; abuse-of-discretion review for expert testimony)
- United States v. Cordoba, 194 F.3d 1053 (9th Cir. 1999) (real-world testing concerns in forensic methods)
- United States v. Sherlin, 67 F.3d 1208 (6th Cir. 1995) (lie-detection concerns; prejudice vs. reliability)
- United States v. Raithatha, 385 F.3d 1013 (6th Cir. 2004) (evidence of billing practices as proof of fraud; CPT coding context)