AROUND THE WORLD CHIROPRACTIC
CHIROPRACTOR CHARGED WITH HEALTH INSURANCE FRAUD
Coldwater, Mich.
COLDWATER — A contentious divorce has led to health care fraud charges being filed against Coldwater chiropractor Sebastian Wilson after a Michigan State Police investigation was conducted by Detective Heather Johnson.
Wilson, 48, was booked into the Branch County Jail Tuesday and released after posting 10 percent of a $20,000 bond. He has been charged with eight counts of defrauding Blue Cross/Blue Shield — each a four-year felony.
According to the probable cause affidavit filed in the cases, Wilson's wife received notice about medical bills for the couple's four children and became suspicious. The claim filed by Dr. Wilson said he performed services for each of his four children June 2 and June 9 at his Coldwater practice, Healing Hands Chiropractic Clinic, at 273 N. Marshall Street.
In reality, court documents said, from May 10 to June 20 the husband had no contact with the children because of a dispute over child support payments.
Dr. Wilson had billed the insurance company and received payments of over $8.000 for the alleged treatment of his children, the court record indicated. A probable cause hearing was scheduled for Feb. 12.
Judge Brent Weigle ordered Wilson not to leave the state except for supervised visitation with his children. Divorce papers were filed by Wilson's wife Angie in October 2013; the divorce was finalized in an Allen County, Indiana court in Fort Wayne on Jan. 6.
This is not the first time Dr. Wilson has been accused of fraudulent billing.
According to records in the Branch County Clerk’s Office, Detroit attorney Lennox Emanuel once represented a driver who sued his own insurance company under the state’s no-fault law after an accident. Emanuel had taken over the case against Fanners Mutual from another attorney, who was also representing Dr. Wilson in a $172,000 claim for treatments for the driver.
Emanuel stopped representing Dr. Wilson when the attorney discovered Wilson had filed claims for six to eight procedures during the driver's 20-minute treatments. According to court transcripts, Emanuel stated not only were the treatments excessive, but that some of the claims filed were dated for days when
the clinic was closed. Dr. Wilson then obtained other counsel.
That case was settled last year in an undisclosed manner according to the case file.
Emanuel also stated on the record that Dr. Wilson asked him to represent him in collecting a $450,000 chiropractic claim stemming from a minor car accident in Steuben County, Indiana in which there was no other medical treatment or hospitalization for anyone involved.
Dr. Wilson filed a grievance complaint with the Michigan Bar against Emanuel, but state records do not show any action against the attorney as the result of that complaint.
Source : http : //www. thedailyreporter. com/
CHIROPRACTOR, CLINIC OWNER ARRESTED IN FRAUD SCHEME
Florida Chief Financial Officer Jeff Atwater announced the arrests last month of a Pompano Beach chiropractor and the clinic operator for allegedly conspiring to create a “straw” ownership arrangement to thwart Florida’s clinic licensing laws. Chiropractor Adam Matthew Strouse. 38. allegedly fronted ownership of Sunnaco Health Center. An investigation by the Division of Insurance Fraud (DIF) determined that Sunnaco Health Center was really owned, operated and managed by non-physician Jean Louis Bernard Celestin, 60. Arrest warrants were issued and Strouse and Celestin were arrested and booked into the Broward County Jail by DIF detectives in December. Strouse claimed to be the owner of Sunnaco Health Center, so the clinic operated with a self-proclaimed exemption since its inception in June 2011, Because Strouse held a license with the Department of Health (DOH), he was statutorily exempt from clinic licensing requirements regulated by the Agency for Health Care Administration (AHCA). Working with the National Insurance Crime Bureau (NICB). DIF discovered that more than $712.000 in fraudulent PIP claims were paid by 14 different insurance companies during the period the clinic operated without a license. Sunnaco Health Center was originally incorporated by Celestin in June 2011, and he added Strouse as a director in September 2013. Strouse has been licensed as a chiropractor in Florida since 2005. Strouse and Celestin aie charged with organized scheme to defraud first degree and operating an unlicensed health care clinic. The case is being prosecuted by the Broward County State Attorney’s Office.
Source : http : //www. myfloridacfo. com/
Pass on the information to inform other D. C. s about events that are really happening to chiropractors. For further information, fax 1-305-716-9212. Write us at [email protected] or UC0138, 8619 NW 68th St., Miami, FL 33166.
