San Diego, CA – A complex investigation into one of the largest cases of workers’ compensation health care insurance fraud in department history has led to 13 indictments announced against seven Southern California-based medical professionals. This is the second wave of indictments against attorneys, doctors and medical providers who ripped off nearly 20 insurance companies by taking kickbacks totaling nearly half a million dollars for treatments including chiropractic, pain management, echo cardiograms and even sleep studies resulting in millions of dollars of fraudulent workers’ compensation insurance claims.
These indictments are the result of a joint investigation by the Department of Insurance, FBI, U.S. Attorney’s Office, and the San Diego District Attorney’s Office. The operation was first announced in November when federal indictments were handed down to eight defendants including doctors and their associates.
“These providers built an elaborate and illegal kickback and bribery scheme that bought and sold patients – putting profits ahead of patient medical needs,” said Insurance Commissioner Dave Jones. “Workers’ compensation is designed to protect injured workers and legitimate businesses, not create a fraudulent profit center for providers bent on taking advantage of the system. Fraudulent enterprises like this create a multi-billion dollar drain on California’s economy.”
Commissioner Jones has made combatting medical provider fraud a major priority for the department, devoting additional resources and establishing a statewide task force to investigate these crimes. He also increased funding to district attorneys across the state to prosecute these crimes, providing nearly $35 million in grant funds this fiscal year.
“The individuals committing the crimes are intelligent people – doctors, lawyers and medical providers who often know how to cover their tracks, making it difficult to catch them,” said San Diego District Attorney Bonnie Dumanis. “But these criminals got greedy, working to expand their criminal enterprise from Los Angeles and Orange Counties, further into San Diego County, looking for more patients, more illegal referrals, and more money in their pockets.”
In addition to the state charges, the U.S. Attorney’s Office announced federal indictments against three additional defendants who allegedly recruited individuals to file workers’ compensation claims resulting from on-the-job injuries. The defendants then directed these patients to specific chiropractors who met a pre-determined quota of referring new patients for goods and services such as MRIs and medical equipment.
Source: CA DOI