AROUND THE WORLD CHIROPRACTIC
Grand jury indicts Jacksonville Chiropractor on Nine Fraud Charges
JACKSONVILLE, FL: A chiropractor with offices in Jacksonville and White Hall has been indicted by a federal grand jury on nine fraud charges accusing him of submitting false insurance claims. Sean Rondeau, who operates Rondeau Chiropractic Center at 1111 W. Morton Ave., was accused of one count of health care fraud, three counts of mail fraud and five counts of wire fraud in U.S. District Court in Springfield.
The charges contend Rondeau submitted fraudulent health insurance claims to health care insurance provider Blue Cross Blue Shield of Illinois, according to documents filed by U.S. Attorney Gregory K. Harris on June 4. The documents that were submitted contained claims for payment for supplies and services that never occurred or never existed and Rondeau also had patients sign blank treatment forms, according to the indictment.
The first count of the indictment contends Rondeau used a software application called EZBIS that allows chiropractors to electronically submit insurance claims. Once submitted to EZBIS, they are sent to a clearinghouse that forwards the claims to the appropriate insurance companies.
Court documents maintain that beginning as early as Oct. 30, 2017, and continuing to at least May 2020, Rondeau devised a scheme to defraud health care benefit programs by means of providing false information.
Rondeau submitted false claims to BCBS via the EZBIS software that he knew were not actually conducted or provided, or not provided to the extent that was billed, according to the complaint said.
When BCBS requested documentation to support the claims, Rondeau gave five patients blank “daily treatment notes” and “daily therapy notes/activities” forms, according to the indictment, and directed them to sign the blank forms and return them. After the blank forms had been signed and returned, the government claims, Rondeau entered treatment and service information on the forms he had not rendered to those patients on the specified times and dates.
The three counts of mail fraud were filed because Rondeau is accused of using the U.S. Postal Service and FedEx to deliver the forms. The three transactions were made in June 2019.
The five counts charging wire fraud involved two patients whose claim information was transmitted to BCBS through interstate wire communications. One claim was submitted July 17, 2019, while a series of four claims were submitted on behalf of one patient between Aug. 28, 2019, and May 4, 2020, according to court records.
An indictment is a formal charge by a grand jury and is not proof of guilt.
Source: myjournalcourier com
Compensation Fraud Scheme
RIVERSIDE, CAOn April 12, 2024, a former chiropractor was sentenced to 54 years, eight months in state prison and ordered to pay more than $23 million in fines for his role in orchestrating a massive workers’ compensation fraud scheme totaling $150 million.
Peyman Heidary, DOB: 8-30-70, was convicted by a Riverside County jury in January 2024 of 68 counts of insurance fraud, conspiracy, money laundering, and various other charges.
“The California workers’ compensation system is designed to help injured workers get back on their feet without ruining them financially,” said Riverside County District Attorney Mike Hestrin. “Sophisticated criminals like Mr. Heidary don’t just steal money, they take advantage of innocent patients. The sentence handed down today sends a strong message that these types of offenses will not be tolerated in Riverside County.”
Between 2009 and 2014, Heidary controlled several sham law firms and a network of sham health clinics. An investigation overseveral years by the Riverside County District Attorney’s Office and the California Department of Insurance revealed Heidary exaggerated patient injuries and ordered his employees to provide unnecessary treatments, resulting in inflated billings to insurance companies.
Heidary used the sham law firm to recruit thousands of legitimately injured patients, referring them to his network of clinics to create unnecessary billing. One of the injured workers, Denise Rivera, slipped and fell while working as a certified nurse assistant for special needs children. Ms. Rivera testified that she was recruited into Heidary’s scheme, but never received any effective treatment.
“[Heidary’s employees] released me,” Rivera told jurors. “They told me ... basically I was okay. My knee was okay.” When asked during the trial if her knee actually was OK, she simply responded, “No.”
Although originally charged with $98 million in fraud, evidence presented at trial, including Heidary’s testimony, revealed that the actual damage was about $150 million. During the sentencing hearing on April 12, 2024, Judge Charles Koosed noted that Heidary possessed deep knowledge of the workers’ compensation system, stating, “’[Heidary] took advantage of that knowledge based on greed.”
The case, RIF1670175, was prosecuted by Deputy District Attorneys W. Matthew Murray and Erika Mulhere
Source: Office of the District Attorney Riverside
Pass on the information to warn other D. C. s about events that are really happening to chiropractors. If you see an article in your local, regional, or national news about chiropractic or a fellow chiropractor, e-mail or mail it to us at: [email protected] or #CO138, 8530 NW 72nd St., Miami, FL 33166.
