CHIROPRACTIC AROUND THE WORLD
Minnesota Chiropractors Going to Prison for Insurance Fraud Schemes
Two Minnesota chiropractors have been sentenced to prison for their roles in separate multi-million-dollar insurance fraud conspiracies, the Minnesota Commerce Department announced.
Adam John Burke, age 34, of Minneapolis, was sentenced to 90 months in prison. Preston Ellard Forthun, age 40, of Bloomington, was sentenced to 60 months in prison.
Both defendants were found guilty last year in separate jury trials before Senior Judge Michael J. Davis in U.S. District Court. Burke was convicted of one count of conspiracy to commit mail fraud and 12 counts of mail fraud. Forthun was convicted of one count of conspiracy to commit mail and wire fraud, six counts of mail fraud and seven counts of wire fraud.
Both Forthun and Burke were licensed Doctors of Chiropractic. As proven at trial they devised separate schemes to defraud auto insurance companies by hiring patient recruiters, known as “runners,” to solicit auto accident victims to attend treatments at their clinics.
Forthun and Burke paid the runners for each patient they recruited, and the runners in turn typically paid the patients to induce them to attend treatments at the clinic. Both fraud schemes were structured in a way that would maximize their clinics’ billings to insurance companies.
Knowing that the runners were paving patients, Forthun and Burke withheld kickback payments to the runners until after the patients had attended a certain number of treatment sessions. Thus, the kickback payments were intended to ensure that patients came for treatments at the defendants’ clinics because of the payments, as opposed to the necessity and reasonableness of the treatments.
As a result of their fraud schemes, Forthun and Burke billed millions of dollars to the insurance companies.
Their cases were the result of investigations conducted by the Minnesota Commerce Fraud Bureau and the Federal Bureau of Investigation. The Minneapolis Police Department, Saint Paul Police Department, Minnesota State Patrol and Homeland Security Investigations provided additional assistance.
Chicago Doctor Convicted on Charges of Billing Insurers for Nonexistent Treatment
A federal jury has convicted a Chicago doctor on fraud charges for billing insurance companies for purported chiropractic manipulations that were never performed, the U.S. Attorney’s Office for the Northern District of Illinois reported.
Dr. Paul Madison, an anesthesiologist and pain management specialist, owned Watertower SurgiCenter FFC, an outpatient surgical center on North Michigan Avenue in Chicago.
The U.S. Attorney’s Office reported that from 2005 to 2009, under Dr. Madison’s direction, Watertower’s billing staff submitted false bills to insurers for manipulation-underanesthesia of body parts that chiropractors at Watertower had not actually performed.
Dr. Madison and others falsified patient records to support the fraudulent health insurance claim forms and submitted the claims to patients’ insurance companies for payment. Evidence at trial revealed that Dr. Madison disguised Watertower’s fraudulent billing by creating false medical and billing records. In at least two instances, Dr. Madison included in the fraudulent billings the names, addresses and dates of birth of patients without their knowledge.
The jury in federal court in Chicago convicted Dr, Madison, 65, of Chicago, on all 11 counts against him. The conviction includes six counts of health care fraud, three counts of making false statements in connection with the delivery of health care services, and two counts of aggravated identity theft. U.S. District Judge Robert M, Dow, Jr,, set sentencing for March 25, 2019.
Each count of health care fraud is punishable by a maximum sentence of 10 years in prison, while the false statement count each carry a maximum penalty of five years. Each aggravated identity theft count carries a mandatory consecutive sentence of two years. The Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
Source: U.S. Attorney’s Office TAC
Source: https://www. insurancejournal. com
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