Chiropractic News Around the World. The Good, The Bad & The Ugly
Healthcare Fraud Sends Three to Jail
GEORGIA: An orthopedic surgeon and chiropractor from metro Atlanta are among a group sentenced to federal prison for a $3 million health-care fraud scam in late November.
Chiropractor, Dr. Arthur Hargraves, 67, of Douglasville, got three years and five months in prison. Dr. Daniel Puffenberger, 52, of Kissimmee, Fla., was sentenced to three years and months in prison.
Orthopedic surgeon, Dr. Howard Berkowitz, 58, of Atlanta got a sentence of one year and six months in prison, because he accepted responsibility prior to trial, and also assisted the government in the prosecution of the case. Berkowitz has already re-paid the entire $2.5 million restitution owed to the insurance company.
Berkowitz, Hargraves and Puffenberger operated a group of back pain clinics in North Georgia and Tennessee known as the Associated Spinal Care Network (ASCN). The three defendants were convicted of running a fraud scheme involving ASCN’s billing for a back pain procedure known as Vertebral Axial Decompression, or “VAX-D,” which is a non-invasive back pain procedure that uses a mechanical table to stretch a patient’s spine. Blue Cross/Blue Shield of Georgia considered VAX-D to be investigational and not medically necessary, and made clear to health-care providers that it did not cover the procedure.
ASCN, at the direction of Berkowitz, Hargraves, and Puffenberger, nevertheless, billed Blue Cross/Blue Shield of Georgia for more than $3 million relating to the VAX-D procedure from 2001, through 2005.
Berkowitz, Hargraves, and Puffenberger were convicted of having lied to Blue Cross about what procedures ASCN was performing in order to get paid for this non-covered procedure. Instead of using the specific billing code assigned to VAX-D, ASCN used a different code that pertained to surgical nerve decompression procedures. The defendants used that code because they knew Blue Cross would pay for it, and would not pay for VAX-D.
Atlanta Business Chronicle
Chiropractor Sentenced for Overbilling
CALIFORNIA: A chiropractor from Los Gatos has been sentenced to two years in prison. 42-year-old Robert Demarco pleaded guilty in May to multiple charges of overbilling insurance companies. Demarco owns the Chiropractic Lifecenter of Los Gatos and had been accused of submitting more than $250,000 in bills to insurance companies between 2004 and 2007 for work he did not do.
Nick Muyo of the Santa Clara County District Attorney’s office says it was Demarco’s patients who tipped off prosecutors. They reported items on their statements that were not included in their treatment, which was covered by their insurance companies.
Silicon Valley News
Chiropractor’s Case Ends in Mistrial
CALIFORNIA: Jury deliberations ended with a mistrial on November 7 in the criminal case of chiropractor Wilmer Origel, who stands accused of performing illegal procedures, over billing insurance companies and money laundering. Jurors deciding the fate of Origel, 48, couldn’t reach a unanimous decision after several days of deliberating, a clerk for the San Joaquin County Superior Court said. The trial began Aug. 19.
The Modesto man faces a prison term on charges stemming from his chain of Med-1 Medical Centers in the Central Valley. He operated one out of his clinic on Wilson Way in Stockton until his 2005.
Prosecutors tried Origel on 11 felony counts. The central charge was that he performed “a controversial procedure called manipulation under anesthetics in which patients are briefly anesthetized to avoid painful adjustments.”
Origel appeared in court again on Nov. 20, at which time prosecutors announced they will not retry Origel.
The Stockton Record
Former Maine Chiropractor Sentenced in Tax Case
MAINE: A former Maine chiropractor is going to prison for two years for health care fraud and tax evasion. At his sentencing in late October in federal court in Portland, 53-year-old Steven Amato was also fined $10,000 and ordered to pay restitution of $100,000 to insurance companies.
Until 2005, Amato operated the Center for Alternative Healing in Damariscotta. He now lives in California.
Amato pleaded guilty in June to one count of health care fraud and three counts of income tax evasion. Prosecutors say that during a four-year period, Amato underreported his income by a total of more than $840,000.
He also allegedly submitted false insurance claims for patient visits that never occurred or that exaggerated the time he spent with patients.