Caribou physician accused of fraud

A federal grand jury has indicted a Caribou physician on 118 counts, accusing him of committing health care fraud, obstructing an investigation, making false claims and other charges.

The charges stem from an investigation by at least three federal agencies into whether surgeries performed by the doctor were medically necessary.

Dr. Osama El-Sayed Abdella El-Silimy, who specializes in treating conditions of the ear, nose and throat, faces up to 15 years in prison and $500,000 in fines. His business, the Aroostook E.N.T. Clinic in Caribou, faces an additional $500,000 in fines.

El-Silimy, 60, was born in Egypt and received his medical education at the Royal College of Surgeons in Scotland. He is a citizen of Great Britain but has practiced in the United States since 1999 when he opened his clinic in Caribou. El-Silimy is the sole officer and physician of the clinic, which has a branch office in Fort Kent. The doctor also practices at clinics in Madawaska and Houlton.

Court documents filed this week in U.S. District Court in Bangor state that El-Silimy and his clinic have been under investigation since May 2001 by the Office of the Inspector General of the U.S. Department of Health and Human Services, the Federal Bureau of Investigation and the U.S. Attorney’s Office for the District of Maine. Evidence presented by federal investigators led the grand jury to issue the indictment on Wednesday.

The investigation focused on whether El-Silimy followed nationally recognized medical protocols to avoid unnecessary surgery for patients with sinus problems.

These guidelines recommend testing for allergies, treating with antibiotics and other medications and obtaining medical images such as CT scans. Only after such measures have been determined to be ineffective will most insurers, including Medicare and Medicaid, consider surgery “medically necessary.”

The indictment states that El-Silimy frequently performed sinus surgery without first trying other diagnostic and treatment options and billed insurers for those surgeries. Court documents also state, based on employee testimony, that when notified of a pending Medicaid audit in December 2001 the doctor and his employees “created, modified and revised” patient records to support the bills submitted.

In January 2002, on the same day federal investigators interviewed about 70 of El-Silimy’s patients, $434,102 was withdrawn from the clinic’s bank account and deposited into a new account opened in the name of the doctor’s wife. The money subsequently was transferred to a bank in the United Kingdom, according to the indictment.

El-Silimy’s attorney, former U.S. Attorney Jay McCloskey, said Thursday that his client will plead not guilty at his arraignment on Aug. 20 and is “anxious for his day in court.”

Federal investigators purposely prejudiced the doctor’s patients against him, McCloskey alleged. “Before this is over, it will be shown that the government’s conduct in this investigation was nothing short of outrageous,” he said.

McCloskey also warned that the case could set a dangerous precedent by criminalizing medical judgment.

“If you go to two doctors, and one says you should have surgery and one says you shouldn’t, has one committed a crime?” McCloskey asked rhetorically. “All doctors and surgeons should be gravely concerned at the implications of this case.”