D.C. Caught Creating False Impairment Ratings With Forged Radiologist Report

aroundtheworldLOS ANGELES, CA — Los Angeles County Superior Court is awarding Allstate Insurance Company more than $7 million in a qui tam action filed by the insurer on its behalf and on behalf of the People of the State of California against a Long Beach chiropractor, Daniel H. Dahan, D.C., and his business, Progressive Diagnostic Imaging, Inc., arising out of a scheme to defraud insurance companies.
In the judgment, Superior Court Judge Ernest M. Hiroshige found that Dahan and Progressive Diagnostic Imaging violated the state’s Insurance Frauds Prevention Act in 487 claims presented to Allstate in radiology reports that were determined to be “falsified medical records” that “have no diagnostic, clinical, or medical value whatsoever.” Hiroshige further concluded that health insurance claim forms and billing statements submitted in connection with the falsified radiology reports were “false and fraudulent.”
The judge ordered that Dahan pay Allstate $4,870,000 in civil penalties, $918,516.78 in assessments and $1,222,151.62 in attorney’s fees, costs and investigative expenses–$7,010,668.40 in all.
Allstate alleged that Dahan purchased report-writing software that purported to analyze x-rays and form medical opinions and diagnoses, including opinions concerning permanent impairment ratings, and thereafter formed Progressive Diagnostic Imaging to solicit x-rays from chiropractors, with the assurance that “board certified radiologists” would analyze the films.
Allstate further claimed that, unbeknownst to patients and health care providers using Progressive Diagnostic Imaging, Dahan recruited untrained and unlicensed individuals to work with the report-writing software to prepare the fraudulent radiology reports. To make it appear that the reports were genuine, Dahan instructed his “technicians” to cut and paste the signatures of board certified radiologists to the reports, all without the knowledge, approval or authorization of the radiologists. The reports and bills were presented to Allstate in support of claims, either directly by Dahan and Progressive Diagnostic Imaging or by plaintiff attorneys in auto accident cases.
At trial, four radiologists, whose names appeared on reports, testified they never wrote, reviewed, approved or signed the reports.
Beyond the verdict, Hiroshige also issued an injunction prohibiting Dahan from owning, operating or working as an employee in any business engaged in the practice of medicine. And he ordered that letters be sent to all of the affected patients and their referring healthcare providers, to advise them of the Court’s findings and judgment, including the Court’s order that the reports generated by Dahan and Progressive Diagnostic Imaging are “to be disregarded on the basis that such reports [are] . . . falsified medical record[s]” and have “no diagnostic, clinical or medical value whatsoever,” and that “records are not to be considered by any person or entity as part of the . . . patient’s medical history, medical record, or medical chart at any time and for any purpose.”

Source:  Allstate Corporation

Colorado, Washington Legalize Recreational Marijuana Use

The same day President Barack Obama was re-elected for his second term, Colorado and Washington became the first two states in the country to legalize recreational marijuana use and possession for people over the age of 21.
Voters approved the Colorado Marijuana Legalization Amendment, also known as Amendment 64, while the Washington Marijuana Legalization and Regulation, Initiative 502, was passed in Washington marking the first time recreational marijuana legislation was passed. 
Amendment 64 lists many restrictions in marijuana use including it being “taxed in a manner similar to alcohol.” Similarly to alcohol, customers are required to present a photo ID when purchasing marijuana.
Those of the legal age will be allowed to purchase up to one ounce of the drug from retail stores and grow up to six marijuana plants in their homes. However selling, distributing and transferring marijuana to minors, driving under the influence and using marijuana in public remains illegal.
Initiative 502 proposes a 25 percent tax imposed when the grower sells marijuana to a processor, again when the processor sells it to a retailer and a third time when the retailer sells it to a customer. 

Source: The Review

PI Chiropractor Convicted of Insurance Fraud

CHESTERFIELD, MO Dr. Anthony Calandro, a Chesterfield resident, and owner of the Chiropractic Accident Centre of Crestwood  was convicted Nov. 8 of billing insurance companies for X-rays never taken and for appointments that the patients had canceled or missed. His billing assistant Sherry Rueter previously pled guilty to related charges.
According to testimony presented at trial, during 2010 and 2011, two undercover investigations revealed that Dr. Calandro and Ms. Rueter billed multiple insurance companies for services that were never rendered. From 2006 to 2011, they submitted numerous reimbursement claims that falsely stated that the Chiropractic Centre had taken more X-rays than were actually taken. In most instances, only one or two X-rays were taken during a patient’s visit, but many more X-ray views were billed. Since health insurance companies would not reimburse Chiropractic Centre if a claim indicated the patient had missed an appointment and had not received a billable service, they falsely indicated that a billable service had been provided to patients. Using false codes, they submitted thousands of false claims for missed appointments.
Calandro and Chiropractic Accident Centre of Crestwood PC were convicted of one felony count of health care fraud. Dr. Calandro was also convicted of three counts of making false statements related to health care services; the corporation was convicted of four counts of making false statements. The four-day trial was held before United States District Judge E. Richard Webber. Sentencing for Dr. Calandro is scheduled for Feb. 7, 2013.
Co-defendant Sherry Rueter, St. Louis, Missouri, pled guilty in October to four felony counts of making false statements related to health care services and is scheduled for sentencing Jan. 24, 2013.
Each count of health care fraud carries a maximum penalty of 10 years in prison and/or fines up to $250,000; each count of making false statements carries a maximum of five years in prison and/or fines up to $250,000. The corporation faces maximum fines up to $500,000 per count. In determining the actual sentences, a judge is required to consider the U.S. Sentencing Guidelines, which provide recommended sentencing ranges.
Additionally, the defendants are subject to forfeiture to the government of all money derived from their illegal activity.
This case was investigated by the Federal Bureau of Investigation. Assistant United States Attorneys Dorothy McMurtry and Dianna Collins prosecuted the case for the U.S. Attorney’s Office.

Chiropractor Cracks, Pleads Guilty to Insurance Fraud for Third Time in a Decade

Ridgewood, NJ: Prosecutors say Craig Klein, of Ridgewood, filed misleading and faulty personal injury claims to auto insurers. He has previous convictions for insurance fraud. A former chiropractor has admitted guilt in running an auto insurance fraud scheme for the third time in a decade, Passaic County Prosecutor Camelia M. Valdes announced Wednesday.
According to prosecutors, Craig Klein, 46, of Ridgewood, paid “runners” to steer accident victims to Hamilton Rehabilitation Center in Paterson and then submitted over 30 fraudulent personal injury claims to automobile insurers from Dec. 2010 and Feb. 2011.
Klein, a co-owner, shared in the profits from the faulty claims, receiving between $500 and $75,000, Valdes said.
He has previous convictions for similar schemes in 2003 in Essex County and in Massachusetts in 2008. The state suspended his license to practice in 2005. Klein admitted guilt in providing false information to insurance companies that his downtown Paterson office was actually legitimate, Valdes said.
Prosecutors allege the chiropractic business – billed as a treatment center for those injured in auto accidents – was anything but.
“He knew that non-chiropractors had an illegal disguised ownership interest in the facility and that the facility paid runners for illegal referrals,” Valdes said in a written statement.
Three other employees of Hamilton Rehabilitation Center were also indicted for their alleged roles in the scheme, according to prosecutors.
Klein pleaded guilty to a charge of theft by deception, a third degree charge that could land him behind bars for five years.
The investigation took over a year and remains ongoing, Valdes said.
Source: Ridgewood-Glenrock Patch

Chiropractor Pleads Guilty to Fraud

LAFAYETTE, LA-A Lafayette chiropractor has pleaded guilty to federal health care fraud charges for billing an insurance company for more than $170,000 in treatments that were not done.

The Advocate reports (http://bit.ly/R7XNg9) Michael Keith Johnsey, of Acadiana Doctors of Chiropractic in Lafayette, faces up to 10 years in prison on three counts of health care fraud in connection with hundreds of fraudulent billings to Blue Cross Blue Shield of Louisiana between 2008 and 2011.

Prosecutors also sought $176,243 in restitution.

Johnsey brought a check for the entire amount to the court hearing Thursday.

“He has been a model citizen and a good man,” said Johnsey’s attorney, Thomas Guilbeau. “He made a mistake and he is stepping up to pay restitution. … He will do whatever he can to restore his name.”
Source: Goerie.com

Phony D.C. Just Wanted to Work

PHILADELPHIA, PA-A Summerdale who posed as a chiropractor and a physical therapist and treated patients as part of an elaborate health-care fraud scheme was sentenced to six years in federal prison.

Tahib Smith Ali, 35, is to surrender to the Bureau of Prisons as soon as he gets a report date, U.S. District Judge Mitchell Goldberg said.

The judge also ordered Ali to make restitution of $287,972, which includes co-pays that Ali allegedly charged to 86 patients.

Ali, who was not licensed and had no medical training, purchased the Oasis Holistic Healing Village, on 17th Street near Spruce, in December 2008 from Dr. Paul Bodhise, a licensed chiropractor who was retiring and moving to California.

Ali told Goldberg that he tried to recruit a chiropractor from Delaware but he couldn’t get licensed here.

“I should have stopped then, but I wanted to make the business work,” he said. “I was afraid of failure.”

After the business began to slow and patients stopped coming, Ali started submitting claims for chiropractic treatments to Independence Blue Cross and other insurers using Bodhise’s name and medical provider number.

“It was the dumbest thing I ever did,” said Ali, who pleaded guilty in June to health-care fraud and aggravated identity theft.

Between January 2009 and April 2010, prosecutors said, Ali submitted bogus claims for $1.4 million and actually received payments of more than $280,000 from IBC and other insurers.

Defense attorney Christopher Hall said Ali was a “good man, a caring man” who had “started with good intentions” but “whose judgment was clouded by a desire to run a business.”

Assistant U.S. Attorney Mary Beth Leahy painted a far darker portrait of Ali, who allegedly wore scrubs and white lab coats when he met with and examined patients.

She said Ali’s “deceit had no bounds” and he had acted “without concern for [patients’] dignity, privacy and health.”

The prosecutor said Ali had even performed muscle-stretching on a 10-year-old girl with cerebral palsy who was wheelchair-bound and unable to speak.
Soure: Philadelphia Daily News

Ohio D.C. Pleads Guilty to Medicare Fraud

AKRON,OH — A Medina chiropractor has pleaded guilty to defrauding Medicare and insurance companies of more than $1.8 million.

Dr. John N. Heary, 38, was accused of submitting fraudulent bills to Medicare, Anthem Blue Cross and Blue Shield, Medical Mutual of Ohio and the Ohio Bureau of Worker’s Compensation, according to the U.S. Attorney’s Office, Northern District of Ohio.

Heary pleaded guilty Friday to seven counts of health care fraud. District Judge David D. Dowd Jr. allowed Heary to remain free on bond until his sentencing, scheduled for April 22.

He could receive a maximum of 10 years in prison, and he likely will lose his medical license, said U.S. Attorney’s Office spokesman Mike Tobin.

Heary was charged with 38 counts of health care fraud, nine counts of mail fraud and eight counts of paying illegal kickbacks. Tobin said 31 counts of health care fraud and all other counts were dropped as part of a plea bargain.

The attorney’s office accused Heary of providing patients with medical treatments that were unnecessary to their health or were more expensive than required.

Medicare and insurance companies reimbursed Heary more than $800,000, which he was ordered to repay, according to the U.S. Attorney’s Office.

Heary operated out of his office at 433 W. Liberty St. He last resided in Westfield Township
Source:  The Medina County Gazzette

Chiropractors Under State Scrutiny in W.Va.

aroundtheworldCHARLESTON, WV.  A new report says West Virginia needs to regulate chiropractors, but questions the performance of the agency assigned that task.
Lawmakers were told Tuesday that the Board of Chiropractic has failed to notify licensees about complaints pending against them. The people who file complaints have been left in the dark as well.
The report to House-Senate interim committees also said the board failed to discipline one chiropractor found to have violated professional standards.
The legislative auditors raise specific concerns about the board’s handling of two recent cases. In one, it renewed the license of a chiropractor indicted on federal health care fraud charges.
The other involved a chiropractor who obtained 31 pain pill prescriptions from four different providers. The board contacted federal authorities, but took no internal actions. 

N.J. Chiropractor Steals from the Blues

aroundtheworldA Matawan, N.J., chiropractor was indicted for allegedly stealing more than $13,000 by submitting numerous fraudulent claims to Horizon Blue Cross Blue Shield.
Charles Boas, 64, was charged with 60 counts of second-degree health care claims fraud and one count of third-degree theft by deception, according to the New Jersey Attorney General’s Office.
Between Oct. 9, 2006 and Aug. 13, 2009, Boas, who worked as a chiropractor in Bayonne, N.J., alleged submitted 60 fraudulent claims to Horizon Blue Cross Blue Shield for chiropractic services that he did not perform.
An investigation by the New Jersey Office of the Insurance Fraud Prosecutor determined that Boas allegedly made false statements and submitted false claims and that he allegedly requested that his patients identify family members and then he submitted fraudulent claims for purportedly treating those family members.
He allegedly received $13,626 from Horizon Blue Cross Blue Shield to which he was not entitled.

Office Manager of Bloomington Chiropractic Practice Arrested

aroundtheworldBLOOMINGTON, IN – 51-year-old Dennis Faulkner, the office manager at Faulkner Chiropractic and Acupuncture in Bloomington was arrested after police say he was wiring money from erroneous credit cards lines made in clients’ names.  According to Bloomington Detective Christopher, Faulkner turned himself into police last week.  According to police the business has a policy in place where a client may establish a line of credit where sessions could be charged. The activity never shows on the client’s statements and no interest would accumulate as long as clients made the minimum payment.  Police say Faulkner allegedly would create the fake accounts, rake in the cash and make the minimum payment. Police say Faulkner established a total of 48 credit lines, accumulating to $210,800 and made $43,000 in payments. At the time of the arrest, he had an outstanding balance of more than $167,000.
When questioned by police, Faulkner said his wife, the chiropractor of the practice, had no knowledge of the operation  He also said the reason he began the operation was to supplement the cash flow of the business because of personal and financial difficulties.  An anonymous caller tipped off the investigation back in early April after the credit company Care Credit contacted Bloomington police.
Source: WBIW.com