Medical Fraud

Published on: August 9, 2010

Los Angeles Healthcare Fraud Experts Weigh in on Breaking Case Out of Miami

Last week, two former operators of a Miami Clinic pled guilty in Federal Court to multiple counts of submitting false claims, committing fraud, and paying kickbacks, prompting a wide ranging discussion among Southern California medical fraud policy wonks.

Jose Nogueira and his brother Rolando Nogueira operated a clinic for AIDS patients called T&R Rehabilitation Professional Corp. They allegedly bilked the government for services that they didn’t provide – particularly expensive HIV infusion services. In April, the government handed down an indictment against the brothers, and they fled the U.S. But the long arm of the law caught up with them. They got apprehended and brought back to Miami for trial for Medicare fraud amounting to over $13.7 million. A sentencing hearing has been scheduled for the 5th of November, and each brother faces a maximum of 40 years in prison for the multiple counts.

Los Angeles Medicare fraud, insurance fraud, credit card fraud, and other white collar crimes can result in massive jail sentences, steep fines, and other grievous penalties. Southern California healthcare fraud is charged according to Insurance Code Section 1871.4 as well as Penal Code section 550. Healthcare employers can also be charged under Labor Code section 3700 and Penal Code section 818. If you are convicted of Southern California healthcare fraud, you can face jail time, loss of your medical license, major court costs and fines, and forced restitution to insurers or Medicaid or Medi-cal.

Published on: August 2, 2010

Southern California Medical Fraud Experts React to Tampa Bust

by Michael Kraut

Los Angeles medical fraud analysts are closely following a breaking story out of Tampa that may have broader implications for white collar crime prosecution. The Hillsborough County Sheriff’s office staged a raid on a local medical rehabilitation clinic on July 16th and arrested four people in conjunction with an alleged scam to bilk insurers by staging fake car crashes.

The four people busted – Jacqueline Rosales, Sugeidi Serrano, Juan Martinez, and Ernie Azucey — will face charges of managing a racketeering influenced corrupt organization – a.k.a, a RICO. Essentially, according to reports, the individuals staged car crashes and then submitted claims to insurance companies for non-existent damage and medical bills.

If you or a loved one faces a similar charge of Southern California white collar crime, you may have a difficult time formulating an effective defense. After all, charges of Los Angeles insurance fraud, Southern California credit card fraud, racketeering, and medical fraud of any kind tend to be multifaceted, dynamic, and extremely complicated. Unless your attorney has experience dealing specifically with your kind of case, you may struggle to be able to come up with an appropriate response to the charges. In short, you could face jail time and other unpleasant punishments.

Published on: July 26, 2010

Southern California White Collar Crime Blogs Weigh in on Massive Medicare Bust

by Michael Kraut

Blogs and local media outlets dedicated to covering breaking news about Southern California white collar crime have been lighting up over a huge Medicare scam bust sprung the Friday before last. CBS and the AP report that, on Friday July 16th, Federal authorities took down 94 people in conjunction with over $250 million worth of Medicare fraud in five states.

This constituted the largest bust of its kind in history.

Suspects were arrested in Baton Rouge, Houston, New York, Detroit, and Miami for doing things like billing Medicare for physical therapy, medications, and treatments that never took place; purchasing phantom equipment; and engaging in elaborate cover up activities. The largest scam took place at the Bay Medical Clinic in Brookline, where authorities contend that the operators of the fraud ring stole $72 million from Medicare by submitting false claims on behalf of senior Russian immigrants. Over 3,700 claims got filed under the name of one elderly woman alone, and many patients literally sold their Medicare numbers to make extra money. At Bay Medical, authorities alleged a room had been set up replete with Soviet Union style propaganda, including a Lenin era poster that warned in Russian “be on the lookout: in these days the walls talk.”

Published on: July 19, 2010

Southern California Medical Insurance Fraud Operation Nets 10 Convictions

by Michael Kraut

Last February, the Orange County DA’s office announced that a dozen individuals had been arrested for Southern California medical insurance fraud in conjunction with an elaborate undercover operation. The latest defendant to be sentenced was Florin Catinas, a 36-year-old chiropractor. After pleading guilty to a felony charge, Catinas received a 60-day jail sentence, more than $4,000 in forced restitution, and three years probation. Catinas could have faced more serious penalties, had he not chosen to testify against a co-defendant, David Gonzalez, in exchange for getting five other felony charges dropped.

Gonzalez himself actually got acquitted of Southern California white collar crime charges back in June — at least on three felony counts. (The jury did not come to a verdict on three other counts, and the prosecution is currently seeking a retrial to try to get Gonzalez on charges of Southern California insurance fraud, grand theft, and unlawful referral of clients.)

The undercover operation involved serious complexity. Investigators created a fake lawyer’s office and sent out letters to chiropractors, doctors, and other providers whom they suspected to be involved in illegal billing schemes. The letter suggested that the lawyer’s office would send referrals to the medical providers in exchange for a 30% commission or kickback – an obviously illegal offer. Out of the dozen people tagged in the operation, only one has been acquitted thus far.

Let’s delve into the specific laws that focus on Southern California healthcare fraud.

Most Los Angeles medical fraud cases can be charged pursuant to Penal Code Section 550 and Insurance Code Section 1871.4. If the provider employs other people, he or she could also be charged pursuant to Labor Code Section 37100. If the provider made a claim to an insurer based on a false statement, the defendant can also face a perjury charge for violating Penal Code Section 118.

Some actions that would constitute healthcare fraud include double billing, creating false medical records, asking for unnecessary patient tests, billing insurers for care that was never delivered, and prescribing meds or doing procedures that were unnecessary.

If you or a loved one or a co-worker faces similar charges of Southern California white collar crime, credit card fraud, or insurance fraud, odds are that you are confused, frustrated, and scared. To develop a strategic and smartly focused defense, you almost certainly need an experienced and tested legal representative in your corner.

Published on: July 12, 2010

Southern California Medical Insurance Fraud Blogs Zero In On Crazy Case Out of Louisiana

by Michael Kraut

As if the Great State of Louisiana didn’t have enough to worry about – Southern California medical insurance fraud blogs have been chasing after a wild story out of Cajun Country, in which an administrative assistant at a chiropractic clinic allegedly pilfered over $77,000 from her employer in an elaborate scam that lasted over three years.

The Dirty Details
Louisiana State Troopers arrested Juanita S. Boyd last week following a five-month investigation into her alleged criminal activities. Ms. Boyd worked as an assistant at a Baton Rouge chiropractic clinic called Advanced Chiropractic. Somehow, she managed to work out an arrangement with a local personal injury attorney named Kevin Hanchey, who referred his clients to Advanced Chiropractic for medical treatment. From 2007 to 2009, Hanchey sent over multiple clients and wrote 39 checks to Ms. Boyd (directly, as opposed to the clinic itself). She allegedly cashed the checks and kept the money for herself – a total of over $77,000, which should have rightfully gone to her boss, Dr. Doyle Johnson.

If you stand accused of white collar crimes – particularly insurance fraud in Southern California – what kinds of charges might you face? The answers depend on the circumstances of what you did. Insurance Code Section 1871.4 is a catch-all for Los Angeles healthcare fraud cases. You might face charges under Penal Code Section 550. If you made a false charge, you could face perjury charges on top of everything else under Penal Code Section 118. And Labor Code Section 37100 might also apply, if you are an employer who committed healthcare fraud.

More generally, Los Angeles insurance fraud is covered under California Insurance Code Section 187. Other types of fraud can be covered under different sections. For instance, auto insurance fraud is covered under Section 1872.8. Depending on the nature of the charge, you could be hit with either a misdemeanor or felony.

As you can see, the legal wrangling over Southern California white collar crime charges can get quite intense and complicated – even if the charges themselves at first appear straightforward. To put up a stiff defense, you want an attorney who has both experience and success dealing with similar situations.

Published on: June 28, 2010

Two Convictions Out of Detroit Put Would-Be Southern California Medical Insurance Fraud Artists on Notice

by Michael Kraut

Individuals contemplating committing Southern California medical insurance fraud should be on notice: the government is cracking down. Last June, the Feds initiated a multi-state bust-up of healthcare fraud operations that allegedly bilked the system out of $50 million, collectively. Two of the biggest alleged offenders – Bernice Brown and Daniel Smorynski – got convicted last week in US District Court of a fraud scheme that bilked Medicare out of more than $6.5 million.

Below are the details about the case:

Between October 2002 and January 2007, Brown (who owned a Michigan-based business called Wayne County Therapeutic) and her Vice President, Smorynski, drafted bogus files to bill Medicare for occupational and physical therapies they never actually performed. All told, they submitted $23.2 million worth of claims to Medicare. The courts came down harshly on both of them. Brown got convicted of 10 counts of healthcare fraud and one count of conspiracy to commit fraud – each of these 11 charges has a maximum penalty of $250,000 in fines and 10 years in jail.

Published on: June 21, 2010

Complex Southern California Medical Insurance Fraud Case Ends with a Guilty Plea

by Michael Kraut

On June 7, a Riverside, California man named Rene Montes entered a guilty plea for dozens of counts of Southern California insurance fraud. The California Department of Insurance reported that Montes pled guilty to felony conspiracy, three counts of felony tax evasion, 59 counts of felony insurance fraud and 59 grand theft felony counts. Sentencing has been set for the end of July. Montes allegedly bilked insurance companies out of $1.5 million by perpetrating a scam to collect funds from AIG Claim Services with respect to outstanding workers’ compensation medical liens.

According to reports, Montes perpetrated the scam from around August 2003 through January 2006. Three other people have also been charged in connection with this Southern California insurance fraud: 47-year-old Cara Cruz-Thomson, 46-year-old Hector Porrata, and 43-year-old George Martinez. The three co-defendants were sentenced in the beginning of May for their connection with the scam. Porrata pled guilty to 50 counts each of grand theft felony and felony insurance fraud as well one felony count of conspiracy. The court ordered him to pay out $1.2 million and serve an 8-year prison sentence. Cruz-Thomson pled guilty to 11 counts each of grand theft and insurance fraud as well as a conspiracy count. She received a two-year prison sentence and an order to pay more than $220,000 in restitution. Martinez also pled guilty to 11 counts of grand theft and insurance fraud as well as a count of conspiracy. He also got a two-year prison sentence and an order to pay around $300,000 in restitution.

The Orange County District Attorney’s office and California Department of Insurance worked together for months to unpack all the subtleties of this Southern California white collar crime.

Published on: June 14, 2010

Southern California Medical Insurance Fraud Experts Closely Watching Desai Case in Nevada

by Michael Kraut

On Friday June 4th, a grand jury indicted Dr. Dipak Desai on 28 criminal counts – from racketeering to insurance fraud – prompting those who follow stories of Southern California medical insurance fraud to vigorous debate the potential fallout.

Dr. Desai – who was charged along with two of his former employees, Ronald Lakeman and Keith Mathahs – allegedly accidently infected over 100 patients with Hepatitis C at his Endoscopy Center of Southern Nevada from March 2004 through January 2008. Patients at his center allegedly got infected because nurses reused syringes. An astounding 50,000 patients in total might have been exposed to HIV and Hepatitis B in addition to Hepatitis C.

Felony counts against Desai include criminal neglect of patients, medical insurance fraud, obtaining money under false pretences, and racketeering. Desai is in the midst of a filing for Chapter 11 bankruptcy, and representatives for plaintiffs have whalloped the embattled physician (former physician actually, since his license was stripped earlier this year) with a slate of malpractice suits. Attorneys said that the insurance coverage “will be grossly and totally inadequate to satisfy the damage claims of plaintiffs.”

Published on: May 24, 2010

Businessman Ordered to Pay $1.3 Million in Southern California Insurance Fraud Case

by Michael Kraut

On May 7th, an L.A. Superior Court Judge ordered local businessman Joseph Baiden to pay over $1.3 million in restitution for committing Southern California insurance fraud. According to a KPCC news story, Baiden had illegally underreported his workers comp pay roll in conjunction with a company called Nurse Connection Inc. He also failed to pay insurance premiums for workers comp. Initially, Baiden had been ordered to spend five years in prison, but Judge Horowitz agreed to allow the 57-year-old Diamond Bar resident to have five years supervised probation, including 90-days of electronic monitoring. In addition, Baiden will have to pay over $100,000 in investigative fees to the California Department of Insurance.

Moving forward, as a result of pleading guilty to Southern California workers comp fraud, Baiden must submit his tax returns to both the DA’s office and the Department of Insurance and offer clear proof both that he has workers comp insurance and that he is in complete compliance with his payment obligations. Baiden will return to court on November 8th to submit a progress report.

Los Angeles insurance fraud charges can be complicated to understand and difficult to fight. Different laws cover different kinds of Southern California insurance fraud. For instance, Penal Code Section S550(a)(5) defines medical insurance fraud; whereas California Insurance code Section 1872.8 spells out the definition of Auto Insurance fraud.

If you or a loved one is being investigated for any kind of Southern California fraud – from life insurance to medical insurance to auto fraud – odds are that you need a reliable, trustworthy, and trial-proven attorney to see you through the difficult legal proceedings ahead.

Published on: May 17, 2010

Southern California Healthcare Fraud Experts Scratch Heads over Double-Edged Decision in Pennsylvania Case

by Michael Kraut

Last Wednesday, a Federal Judge gave a Pennsylvania doctor, John Kristofic, a year and a day in prison pursuant to a healthcare scam that lasted from 2003 to 2008. Southern California healthcare fraud experts have been poring over Judge Ambrose’s decision to determine whether and how the decision might be impact local cases. dr-John%20Kristofic.jpg

The perplexing saga of Dr. Kristofic
The 62-year-old Dr. Kristofic (of Shadyside, PA) has a long and tumultuous history with the law. Back in the 1980s, he was brought up on charges under the Racketeer Influence and Corrupt Organizations Act of stealing more than a $1 million by billing for non-medically necessary tests. He allegedly invested the proceeds of this scam into private commercial real estate. The doctor settled that case for $0.75 million. He was later arrested and convicted of driving under the influence, AND he got probation for lying about his asset portfolio in 1991.

His latest arrest pertains to similar charges. From 2003 to 2008, Dr. Kristofic allegedly unfairly billed Medicare and other private insurers for services he never provided to his patients. Many Southern California healthcare fraud experts — at this point reading about Dr. Kristofic’s bio –would feel pretty confident that his repeated chronic violations of the law should merit a harsh sentence.

But… the story thickens.

It turns out that Dr. Kristofic has another side — an altruistic and giving one. Among other things, he provided free medical care for organizations like Operations Safety Net, Alcoholics Anonymous, and Catholic Charities. In a 2006 trip to Haiti, he gave out free care to the sick, an act which a local Reverend said “exuded a sense of compassion… it was extraordinary.” And Judge Ambrose received 60+ letters from various people and organizations commending Dr. Kristofic for his charity and extraordinary givingness.

As you can see, cases of Southern California insurance fraud can be a lot more complicated than they first appear in the headlines.

If you or a family member has been charged with healthcare fraud or any other white collar crime in Southern California, consider protecting yourself by retaining high quality legal counsel.