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.