AROUND THE WORLD CHIROPRACTIC
TWO CHIROPRACTORS ARRESTED FOR ROLES IN HEALTH CARE FRAUD SCHEME CONNECTED TO CLINICS IN BAKERSFIELD, VISALIA, AND FRESNO
U.S. Attorney’s Office July 09, 2015
Eastern District of California(916) 554-2700
FRESNO, CA—Following arrests made earlier today, a federal indictment was unsealed charging three defendants with conspiracy to commit health care fraud and 15 counts of health care fraud, United States Attorney Benjamin B. Wagner announced.
Chiropractor Bahar Gharib-Danesh, 38, of Woodland Hills, was arrested in Los Angeles; Chiropractor Na Young Eoh, 41, of Bakersfield, was arrested in Bakersfield; and clinical psychologist John Terrence, 72, of Marina Del Rey, is expected to voluntarily appear before the U.S. District Court in Fresno within the next 30 days.
“Identifying and prosecuting fraud in the provision of health care services is a priority for this office.” said U.S. Attorney Wagner. “We will continue to work with our federal and state partners in pursuing dishonest health care providers who plunder public and private health care insurance plans for their own gain.”
According to the indictment returned on July 2, 2015, Gharib-Danesh was a chiropractor and the manager of Pain Relief Health Centers (PRHC). PRHC was headquartered in Los Angeles, and had clinics in Bakersfield, Visalia and Fresno, as well as in Los Angeles County. Eoh was also a chiropractor, and was the treating physician for PRHC’s Kern County workers’ compensation claims. Terrence was a clinical psychologist who saw patients from the Bakersfield clinic.
According to the indictment, PRHC recruited patients who were workers claiming to have an injury. In treating the patients. Gharib instructed her staff to add as many injured body parts for treatment as possible to generate higher billings. The treatment plan generally included shock wave therapy, electro stimulation therapy, myo-facial release/massage, physical therapy, chiropractic manipulation, compound creams, and psychological evaluation. Nearly every patient was scheduled for the same treatments, and the maximum amount of treatments allowed by law was generally billed to the insurance company, Eoh operated out of the Bakersfield Clinic, the Visalia Clinic, and the Fresno Clinic and would sign the treatment plans and referral forms.
If the claim of injury was denied by the insurance company, a lien would be filed, and the claims would either be litigated before the California Workers’ Compensation Appeals Board or be settled by negotiations through the parties. Lien settlements for less than the full amount of the claim were acceptable because of the high volume of patients recruited and by the large amount of medical fees generated.
The indictment further alleges that Gharib directed Eoh to refer all patients who came into the clinic to Terrence for a psychological evaluation, regardless of the injury the patient reported. Terrence submitted bills and reports for each patient that were virtually identical. He also allegedly fraudulently billed for patients at a rate higher than legally allowed. According to the indictment, Terrence provided each patient with approximately 20.8 hours of psychological evaluations in a single day. On one day, Terrence billed a total of 291.2 hours for treating 14 patients. In one period of two weeks, Terrence billed over a thousand hours treating patients and writing reports. Between 2005 and 2012, Terrence submitted
claims for psychological services in workers’ compensation cases totaling in excess of $5.6 million.
This case is the product of an investigation by the Federal Bureau of Investigation, the California Department of Insurance, and the Kem County District Attorney’s Office. Assistant United States Attorneys Mark J. McKeon and Patrick R. Delahunty are prosecuting the case.
If convicted, each defendant faces a maximum statutory penalty of 20 years in prison and a $250.000 fine on each count of the indictment. Any sentence, however, would be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables. The charges are only allegations; the defendants are presumed innocent until and unless proven guilty beyond a reasonable doubt.
Source: FBI.gov
TWO-YEAR FLORIDA INSERANTE FRAUD INVESTIGATION LEADS TO MULTIPLE ARRESTS
The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) has made multiple arrests related to a large-scale personal injury protection (PIP) fraud scheme spanning across Central Florida. Five individuals have been arrested for their alleged various roles in the scheme, and arrest warrants have been issued for three additional individuals whose arrests are pending. Three related arrests have been made in the Fort Myers area.
DIF partnered with the FBI to conduct investigations into two personal injury clinics, First Medical Rehab of Bradenton (FMRB) and Kirkman Family Chiropractic Care (KFCC) in Orlando, after insurance carriers and former patients raised allegations of potential illegal activities.
In the early months of 2014, a DIF detective successfully infiltrated the Bradenton clinic by going undercover and posing as a patient. As a direct result, investigators were able to prove that FMRB was allegedly billing for medical treatments on injuries that did not exist.
The investigation into Kirkman Family Chiropractic revealed an organized plot to circumvent clinic licensure requirements set by the Agency for Health Care Administration. Because licensed health care professionals can operate clinics without the necessity of an additional clinic license, co-conspirators solicited licensed chiropractors to serve as straw owners, or owners on paper only.
To date, more than $100,000 in fraudulent claims has been paid by multiple insurance carriers.
Those who were arrested include:
• Dadline Prospere
• Shona S. Johnson
• Dieufort Irilus
• Evelyne Franclin
• Barry Sutphin
Charges are varied based upon each individual’s alleged role and include: Patient Brokering, Conspiracy to Commit Patient Brokering, False and Fraudulent Insurance Claims, Solicitation, Grand Theft, Organized Scheme to Defraud and Conspiracy to Commit Insurance Fraud. All subjects, if convicted, face anywhere from 5-30 years in prison and could face fines as large as $10,000.
Source: http./Avww. insurancejournal. com/ gQg
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