Mother Faces Prison Time, Probation & Fines for Chiropractic Fraud

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San Francisco, CA- A Phoenix woman will be serving time and paying fines after being found guilty of defrauding a health and life insurance company of almost $690,000. After making fake chiropractic claims, forty two year old Esther Obrzut is facing not only prison time and probation, but hefty restitution as well.
 
According to an announcement from Arizona Attorney General Tom Horne, Obrzut was sentenced to two and a half years in prison for forgery, and an additional five years for fraudulent schemes and artifices. She was also ordered to pay the Cigna Health and Life Insurance Company $650,000 in restitution.

According to the prosecutors, Obrzut billed the company over a million dollars for nearly forty-five hundred chiropractic treatments for herself, her two minor children, and her husband between the months of May of 2003 and February of 2011. Although the company paid out almost $685,000, the Arizona Department of Insurance Investigators determined that the family never received those treatments.
 
“Medical insurance fraud is a significant crime because it drains resources that insurers need to make sure that people who are truly sick get the treatment they need,” said Attorney General Tom Horne. He added, “My office is committed to vigorous prosecution of fraud and I am very pleased to see that the perpetrator in this case will not only pay restitution, but will spend time behind bars.”
 
 

British Physiotherapists and Podiatrists Become the First in World to Prescribe Medicines to Their Patients

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UNITED KINGDOM–New legislation means they will no longer have to refer patients back to a General Physician (GP) or other healthcare workers if medications such as painkillers and anti-inflammatories are needed, the Department of Health (DH) said.  A DH spokesman said ‘advanced practitioner’ physiotherapists and podiatrists in the UK would be the first in the world to be able to independently prescribe medicines where ‘clinically appropriate’.
 
Under the new legislation, physiotherapists will be able to prescribe medicines for issues such as chronic pain and respiratory diseases like asthma.  Podiatrists, who treat disorders of the foot, ankle and lower leg, will also be able to prescribe medication for their patients. The College of Podiatry said the move will particularly benefit diabetic patients with infections of the feet and people suffering from other infections such as wounds and ingrown toenails and fungal infections.  Health minister Lord Howe said: ‘Physiotherapists and podiatrists are highly trained clinicians who play a vital role in ensuring patients receive integrated care that helps them recover after treatment or manage a long-term condition successfully.
 
Health Minister Lord Howe hopes the changes mean patients can get medicines more easily
 
‘By introducing these changes, we aim to make the best use of their skills and allow patients to benefit from a faster and more effective service.’ The Chartered Society of Physiotherapy (CSP) welcomed the move, saying it will mean that patients are offered quicker and more direct access to the medicines and treatment they need.
 
CSP chair Dr Helena Johnson said: ‘Giving physiotherapists the opportunity to prescribe independently will hugely improve the care we can provide in the future.
  
‘Patients will now receive a more streamlined and efficient service, meaning they get the medicines they need more immediately. ‘An unnecessary burden will be removed from doctors, with physiotherapists taking full responsibility and accountability for the prescribing decisions they make.

‘For patients, the chance of faster relief from pain or other symptoms will also mean many can benefit more quickly from their physiotherapy treatment.’
 
Alison Wishart, chair of the Society of Chiropodists and Podiatrists, said: ‘Independent prescribing provides podiatrists with the opportunity to deliver more flexible services for patients – ensuring timely access to medicines, care closer to home and enabling innovation.’
 
The new legislation is expected to come into effect in April next year, with the first intake of podiatrists and physiotherapists to go into Health Professions Council-approved education programmes in autumn.
 
 
Source: Daily Mail

Chiropractor Faces 125 Fraud Counts

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PATERSON, NJ–A chiropractor with offices in Paterson and Jersey City has been charged with 125 counts of insurance fraud for allegedly faking the claims of car accident victims so that they would appear to need continued care, the state attorney general said Tuesday.
 
Joseph Salomone, 44, a resident of Nutley who owned the Pain and Injury Center of North Jersey on Broadway in Paterson, allegedly stole more than $89,000 by filing false documentation to insurance companies.
 
He allegedly “kept the patients coming for months and months of chiropractic care by falsifying the results of examinations so that they always supported continued treatment — and continued billing,” said Attorney General Jeffrey S. Chiesa. The case was brought by Ron Chillemi, the acting insurance fraud prosecutor for the state.
 
Besides the Paterson office, Salomone is president of Salomone Chiropractic in Jersey City and had run the now-defunct Pain Relief Health Center of New Jersey in East Orange, the Attorney General’s Office said.

The indictment by a state grand jury said that between Aug. 16, 2007, and June 4, 2011, Salomone asked his office workers to fill in forms about the range-of-motion tests of 37 patients who were car accident victims with information that didn’t come from actual assessments of the patients. Eleven of the patients were treated at the Paterson office, 14 in Jersey City and 12 in East Orange.
 
This fraudulent documentation was then submitted to Allstate Insurance Co., High Point Insurance Co., Liberty Mutual Insurance Co., New Jersey Manufacturer’s Insurance Co. and United States Automobile Association as part of the billing process, the indictment alleges. Through this fraud, the indictment said, Salomone sought nearly $200,000 in reimbursements and received $89,283.
  
The maximum sentence for each second-degree crime is 10 years in state prison and a fine of up to $150,000. Salomone remains licensed as a chiropractor, a spokesman for the state Board of Chiropractic Examiners said.
 
Source:  The Record
 

State Farm Insurance on Trial for Inflammatory Accusations Against Chiropractor

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PA – A Pennsylvania chiropractor can proceed with a claim that State Farm Insurance defamed him in an attempt to ruin his business, a federal judge ruled. Peter Schatzberg, who has a doctorate in chiropractic, says State Farm arbitrarily began characterizing all soft-tissue injury claims as fraudulent, as part of its practice to treat “the entire chiropractic industry as fraudulent as well.”
 
“If a claimant is a minority, an immigrant, or from a poor urban area, State Farm automatically looks on their claims as potentially fraudulent,” according to the complaint Schatzberg filed in 2010.
 
The lawsuit claimed that State Farm defamed Schatzberg in letters to his office and to his attorney, accusing him of “professional impropriety,” merely because he is a chiropractor who treats soft-tissue injuries.
 
State Farm falsely accused Schatzberg of having engaged in fraudulent business activity, created a false perception in the community that he engaged in professional impropriety, and engaged in a pattern of racketeering activity, according to the complaint. Through its Advancing Claims Excellence program, the insurer systematically paid significantly less than the legally required amount for treatment that Schatzberg provided to individuals insured by State farm insured, he said.
 
That program allegedly operated with help from a special investigations unit and outside counsel. Schatzberg claimed that Doug Babin, one of the adjusters with State Farm’s special investigations unit, called current and former employees of the chiropractic practice, identified himself as a “fraud investigator,” and asked about Schatzberg’s billing practices in an “aggressive tone.”
 
State Farm fired back that Schatzberg had failed to adequately state a claim, and said the entire case should be dismissed for lack of federal jurisdiction. But U.S. District Judge Gene E.K. Pratter said the allegations about Babin could support the defamation claim.
 
“While the court appreciates State Farm’s argument that Mr. Babin’s statements were made in the course of satisfying State farm’s statutory mandate that, as a motor vehicle insurer, it maintain a motor vehicle insurance antifraud plan, based on the facts alleged, Mr. Babin’s statements, coupled with his allegedly ‘aggressive tone,’ could lead one to believe … that State Farm possessed facts or information that Dr. Schatzberg was engaging in or had engaged in fraudulent billing practices or criminal conduct,” the decision states.
 
The letters sent to Schatzberg and his attorneys also support defamation allegations, Pratter found, despite noting that one of the implicated letter was just “barely” defamatory. Schatzberg did fail, however, to substantiate his claims of false light or invasion of privacy. The complaint makes no mention of a claim that State Farm published any of its investigators’ alleged statements in a newspaper, periodical or other sort of publicly circulated medium, according to the decision. 

“Rather Dr. Schatzberg’s claim centers on two primary contentions: (1) State farm spread false information about Dr. Schatzberg to particular individuals in the medical and legal communities via letter and phone call, and (2) State Farm deployed [ ] Goldberg in litigation for the purpose of sending a false message to the legal community that Dr. Schatzberg was engaged in wrongdoing,” Pratter wrote. “Neither of these actions on the part of State Farm constitutes publicity for the purpose of a false light invasion of privacy action.”
 
Schatzberg’s RICO claim also failed to meet the bar, and Pratter refused to exercise supplemental jurisdiction over the state-law claims. 
 
 

10 Arrested in Massage Parlor Sting

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BELLEVUE, WA -10 people were arrested and three others cited for having fraudulent massage practitioner licenses.

The arrests were part of an on-going investigation of people submitting suspected counterfeit Chinese school and licensing credentials while filling out the Practitioner Licensing Applications required by the Washington State Department of Health.

The investigations have shown that the individuals suspected of committing these acts were unable to receive the listed massage training in China during the times listed on the applications.

To date, 20 individuals have been arrested by Bellevue Police as a result of this investigation.

The investigation began in September, 2011 when the Bellevue Police vice division received information from the state health department and the U.S. Immigration and Customs Enforcement’s (ICE) Homeland Security Investigations (HSI) that a number of regional massage practitioner’s licenses had been obtained fraudulently.

During the Thursday arrests, HSI and U.S. Customs and Border Protection provided Mandarin translators.

Source: BellevueReporter.com

Man Buys Chiropractic Clinic, Then Treats Women

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PHILLADELPHIA, PA FROM THE OUTSIDE, the Oasis Holistic Healing Village, housed in an Italianate former mansion on a leafy block near Rittenhouse Square, appeared as serene as its name suggested.

Except that behind the extravagant stone facade, the man wearing the scrubs inside the chiropractor’s office was a liar, a thief and, judging by what law-enforcement sources say, a creep.

Federal prosecutors say Tahib Smith Ali had no license or medical certification when he bought the business from a chiropractor in December 2008. But that didn’t stop him from examining patients and performing treatments on them, including “muscle stretching and spinal manipulation,” according to court documents.

He allegedly had a particular affinity for women. One source who asked not to be identified said that after Ali hired a part-timer, he would examine the attractive patients and pawn the others off on his employee, a licensed chiropractor, when she was in the office.

Ali then filed more than $1.4 million in bogus claims from January 2009 to April 2010, the documents said. Independence Blue Cross paid out more than $280,000 during that time.

Several female patients were expected to testify at trial about Ali’s interaction with them, but they never got the chance.

Just before jury selection was to begin Tuesday, Ali pleaded guilty to 50 counts of health-care fraud, 50 counts of making false statements and one count of aggravated identity theft. U.S. District Judge Mitchell Goldberg did not set a date for sentencing.

Ali, 35, of the Summerdale section of Northeast Philadelphia, could face as many as five years in a federal lockup, including a mandatory minimum two years for stealing the identity of Paul Bodhise, the licensed chiropractor from whom Ali bought the business.

Assistant U.S. Attorney Mary Beth Leahy said in a court filing that Ali had “submitted more than $1.4 million in fraudulent claims for chiropractic services to Independence Blue Cross under Bodhise’s name and medical provider number even though he had moved out of state and no longer treated patients at Oasis.”

This wasn’t even Ali’s first time manipulating the chiropractic game. When he bought Oasis, he was on probation for a state conviction in Montgomery County in July 2007, for his role in an insurance-fraud scheme in which a Philadelphia-area chiropractor submitted millions of dollars in fraudulent claims to insurance providers for services that were never rendered.

Leahy said in court papers that Ali worked for the chiropractor and met patients to have them sign phony “treatment sheets indicating they had been treated by the chiropractor when they had not received any treatment at all.” The court filing said Ali was paid $49,000 for his role in the scheme. He was sentenced to two years’ probation.

At Oasis, Ali operated without any chiropractor on staff from January to late August 2009, when he hired the licensed chiropractor, Valda Dawson, to work about eight hours a week. “Dawson saw four patients at most, but usually less, on days she worked, and was paid $40 for each patient she treated,” Leahy said in a court document.

Had the case gone to trial, Dawson was expected to testify for the government. She did not submit any claims to IBC or any other insurance provider for her services while working for Ali.

Prosecutors said Ali submitted claims to IBC for Dawson’s patients, also using Dr. Bodhise’s identity, that included procedures Dawson did not perform. Dawson could not be reached for comment.

IBC investigators were tipped off to Ali, Leahy said, when the number of claims submitted under Bodhise’s provider information “spiked dramatically to $1.4 million for 2009 compared to approximately $316,000 for 2008.”

In 2009, claims submitted for Bodhise were among the highest for all IBC participating chiropractors nationwide, court papers said.

By late 2009, IBC began to investigate complaints from insured patients who reported that Oasis had submitted claims on their behalf for office visits that never occurred and for services that were not performed.

Ali, who was released on $50,000 unsecured bond after his arrest in July 2011, remains free pending sentencing.

Source: Philadelphia Daily News

FBI: Chiropractor Planning Escape Arrested

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DAYTONA BEACH, FL —
Anticipating Joseph Wagner would bolt for the Dominican Republic where he was supposed to marry a prostitute, the FBI arrested the 62-year-old chiropractor in May, charging him with dispensing controlled substances and health care fraud according to federal investigator.

Wagner’s practice — Wagner Chiropractic and Acupuncture Clinic — was raided in August 2011 by the FBI and other federal agencies. The agents were seeking any evidence that would show Wagner was dispensing controlled substances — specifically Xanax and Lortab — and defrauding insurance companies, according to a criminal complaint.

Not only were patient records seized at the Daytona Beach clinic, but financial and computer records were also taken. Wagner’s financial records revealed he has a bank account in the Dominican Republic — where he went to medical school — for $76,800. That’s the equivalent of about $3 million pesos in that country, the complaint shows.

After the raid, state and federal investigators revealed Wagner was linked to a West Palm Beach doctor who investigators said allowed Wagner to use the doctor’s Drug Enforcement Administration license. That enabled Wagner to prescribe pain medications to his chiropractic patients, investigators said. State law prohibits chiropractors from prescribing medication.

The license of that medical doctor — John Christensen — was suspended by the state, as was Wagner’s, records show. Christensen said Friday he never gave Wagner permission to use his name for prescriptions.

According to the complaint released Friday though, Wagner used the names of other medical doctors for the prescriptions, as well. The prescription pads Wagner used were pre-stamped and pre-signed using the names of those doctors, the complaint shows. Christensen’s name appeared on some of the prescription bottles of Wagner’s patients, investigators said.

All of the patients were given Xanax, Lortab and the muscle relaxer Soma, the complaint shows. Some of the patients received their drugs monthly, others got them weekly, the complaint shows. Patients who had no insurance paid Wagner $100 monthly and were given their drugs that way, the complaint shows.

The patients said they received a “back crack” from Wagner and office visits never lasted more than five minutes, the complaint shows.

Investigators learned Wagner traveled to the Dominican Republic twice in April. Both were round-trip journeys.

But when he booked a trip to Santiago, Dominican Republic, for May 16, it was a one-way ticket, the complaint shows.

“On May 15, I received a call from the confidential source,” FBI agent Groeschner wrote in the complaint. “Joseph Wagner planned to remain in the Dominican Republic for at least a month, and intended to marry a prostitute he met there before allegedly returning to the United States at an unspecified, later date.”

Source: Orlando Sentinel

Out of Work D.C. Accused of Using Cat Calls to Win Children’s Trust

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HIALEAH, FL. A.,
  — man who Hialeah police say took videos of young children in department stores has been accused of similar charges.

Out of work chiropractor Jonathan Davis turned himself in to authorities late Friday night and posted bail shortly after being charged with aggravated stalking of a minor under 16.

Davis was arrested in May on charges of committing a lewd act at a Hialeah K-Mart store.

Police obtained a warrant for Davis’ cell phone and say videos stored on the phone show him seeking out girls younger than 12, and videotaping them.

Hialeah police provided an edited surveillance video and cell phone audio recordings of Davis at a Burlington Coat Factory in Hialeah to CBS 4 News.

Police say the audio recordings show a man desperate to catch the attention of the children, using catcalls and laughter to entice them and win their trust.

All the while, police say Davis touched himself inappropriately, using a ruse that he was “itchy” to elicit help from the youths.

Hialeah police said the case began because an alert security guard at the Burlington Coat Factory noticed Davis recording children in the store at the end of March. The surveillance video shows store cameras zooming in and out on Davis as he roamed the store.

Mendigutia says Davis got just inches away from some children who were with their parents.
“In some cases I could actually see that a parent was holding a child by the hand,” Mendigutia said. “In some cases the parent was 5 feet from their child.”

Police say Davis appeared to be on the prowl, crouching down in store aisles and hiding behind merchandise — all in an effort to surreptitiously take video of girls as young 5, while touching himself.

And the audio recordings add another creepy element to this case. Police say Davis used a series of catcalls to get the kids’ attention — making a “psst” noise and saying “Ouch!”

Police say Davis also tried to get the girls to go with him to a different part of the store.

 “He’s saying things like ‘Where’s the toy section? I have a little niece. Can you help find this? What size shoe are you?’ ” Mendigutia said.

Investigators do not believe any children went with Davis but they continue to investigate the case.

Police do believe Davis did this at numerous stores.

Police say “The parents that were close to their kids, he couldn’t go that next step,” Mendigutia said. “The parent was too close by. So staying close to your children is always going to be the safest thing to do.”

According to the clerk’s office in Iredell County in North Carolina, Davis pleaded no contest to three counts of indecent exposure in 2007. A copy of a police report reveals that Davis was accused of exposing himself to several people – including a 15-year-old — at a park. The clerk’s office tells CBS 4 that Davis was sentenced to 2 years of supervised probation, told to pay court costs and ordered to stay out of parks and playgrounds.

If you believe your child may have encountered Davis, call Hialeah police at (305) 863-5353

P.I. Fraud Sting Nabs Chiropractor in Bridgeport

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BRIDGEPORT, C.T. — A Milford chiropractor faces up to five years in prison after admitting to conspiring to make false statements relating to health care matters as part of a million-dollar fraud scheme.
Jennifer Lynne, 39, who owns and operates The Backstroke on State Street in Bridgeport, waived her right to indictment and pleaded guilty Thursday before U.S. District Judge Stefan R. Underhill, according to a news release from the office of U.S. Attorney David B. Fein.  Lynne will be sentenced on June 7 and faces a maximum of five years in prison and up to a $250,000 fine.
 
Four others have pleaded guilty — including two chiropractors, a licensed doctor of osteopathic medicine and a formerly licensed physician — as part of “Operation Running Man,” a 14-month undercover fraud investigation led by the FBI. An undercover special agent recorded meetings with an attorney, various doctors and chiropractors arising out of auto-accident personal injury litigation, according to the news release.  Lynne is a licensed chiropractor who worked for Marc Kirshner, a chiropractor who owned a practice with offices in Stamford and Bridgeport.
 
Between about December 2006 and February 2010, Lynne, Kirshner and another chiropractor employed by Kirshner, Jennifer Netter, performed unnecessary chiropractic treatments on individuals who were involved in auto accidents, according to court documents and statements made in court.
Prosecutors said that as part of the scheme, Lynne and Netter, directed by Kirshner, routinely established six-month treatment regimens for patients, regardless of medical need. They also conspired to falsify medical records, including fake patient assessments and exaggerated injury reports. These reports were then passed along with health insurance claims for payment to insurance companies.
 
Kirshner pleaded guilty to one count of conspiring to commit mail fraud and admitted his role in the conspiracy led to the loss of about $1.69 million by 10 insurance carriers.
Netter, a 38-year-old Danbury resident who was pregnant at the time, pleaded guilty on July 20, 2011, to one count of conspiring to make false statements relating to health care matters. Netter allowed her chiropractor’s license to become inactive on Sept. 30, 2010.
 
Francisco R. Carbone, a 54-year-old former Bridgeport doctor and psychiatrist pleaded guilty last summer to four federal charges relating to the scam. Dr. James W. Marshall, who operates Immediate Medical Care on Main Street in Monroe pleaded guilty to illegally writing prescriptions at Carbone’s request for narcotic painkillers to patients he never saw.
Court documents claim that an unnamed Bridgeport attorney, with personal injury clients receiving some sort of state aid, sent clients to the chiropractor’s offices for treatment. Carbone, whose license to practice medicine was pulled by the state in 2005, would recommend pain killers and Marshall would prescribe them. Carbone would also require patients to undergo nerve conduction velocity testing at a diagnostic testing center owned by Kirshner. The tests cost $2,000 each. When the lengthy treatments were finished, Carbone would write final medical reports claiming patients suffered permanent disabilities in the accidents.
 
Kirshner, Netter, Carbone and Marshall are all awaiting sentencing. The investigation is ongoing and the unnamed Bridgeport lawyer is reportedly a target of the probe.

Emerging Science Reveals Chemicals From Myriad Sources Show Up in Food and May Be Harmful at Lower Amounts than Thought

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New York, N.Y.,  –On the heels of the decision last month by the U.S. Food & Drug Administration (FDA) to allow continued use of the chemical bisphenol-A (BPA) in food packaging, a new report today, “If Food is in Plastic, What’s in the Food?” in the Washington Post, produced in collaboration with the Food & Environment Reporting Network, looks at how people are exposed to BPA and other chemicals through food-contact plastics and explores the potential impacts on human health. The article, by reporter Susan Freinkel, author of Plastic: A Toxic Love Story, examines the emerging science on such chemicals which may interfere with natural hormones and be harmful at extremely low levels of exposure.
 
applesinplasticwrapBPA and phthalates are among the 3,000 chemicals that the FDA has ruled safe if they get into food in very low amounts. The report notes that a number of these chemicals used in food processing and packaging materials have shown up in food. Some scientists question their safety, in part because these chemicals have not yet been studied for their cumulative effects. In addition, research proves difficult because companies often consider their formulas proprietary.
 
“Finding out which chemicals might have seeped into your groceries is nearly impossible, given the limited information collected and disclosed by regulators, the scientific challenges of this research and the secrecy of the food and packaging industries, which view their components as proprietary information,” Freinkel writes. “Although scientists are learning more about the pathways of these substances – and their potential effect on health – there is an enormous debate among scientists, policymakers and industry experts about what levels are safe.”
 
Freinkel explains how plastic food packaging is a major source of these potentially harmful chemicals, which most Americans harbor in their bodies. For instance, studies have shown phthalates—a family of chemicals used in lubricants and solvents and which imparts flexibility to plastics—passing into food from processing equipment and food-prep gloves, gaskets and seals on non-plastic containers, inks used on labels—which can permeate packaging—and even the plastic film used in agriculture.
She highlights a forthcoming study that found the phthalate DEHP in many of the 72 different grocery items sampled. Studies have associated low-dose exposure to this chemical with male reproductive disorders, thyroid dysfunction, and subtle behavioral changes.
 
Last month, the FDA denied a petition to ban BPA, saying in a statement that while “some studies have raised questions as to whether BPA may be associated with a variety of health effects, there remain serious questions about these studies, particularly as they relate to humans and the public health impact.”
For additional reporting on the story, see http://thefern.org