In 2006, Mark Chan Monwai, N.D. founded the Cornerstone Family Health Clinic in Kirkland, Washington and became its clinical director. He was appointed to the Washington State Board of Naturopathy for a 3-year term beginning in August 2011 and served as its chairman during part of his term. In March 2015, the board charged him with unprofessional conduct that involved falsifying insurance claims and failing to cooperate with a board investigator. An insurance department news release indicates that some of the falsified claims were submitted using the name of a former employee after the insurance companies had canceled his contract as a provider.
In June 2015, Monwai pleaded guilty to insurance fraud and was ordered to repay the insurance companies, pay a $600 fine, and provide 250 hours of community service. In July, the board updated its complaint and summarily suspended his license. The amended statement of charges (shown below) states:
- Between 2009 and 2014, he submitted more than 150 insurance claims in which the person identified as the provider had not administered the treatment.
- When the board asked for certain relevant records, he changed the provider names before submitting them.
In July 2015, the board concluded that Monwai constituted “an immediate danger to public health” and summarily suspended his license pending further proceedings.
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
BOARD OF NATUROPATHY
|In the Matter of:
The executive director of the Board of Naturopathy (Board), on designation by the Board, makes the allegations below, which are supported by the evidence contained in case nos. 2012-1812, 2014-2988, and 2014-5321. The patients referred to in this Amended Statement of Charges are identified in the attached Confidential Schedule.
1. ALLEGED FACTS
1.1 On March 28, 2002, the state of Washington issued Respondent a credential to practice as a naturopath. Respondent’s credential is currently active.
1.2 During all times relevant to the allegations below, Respondent owned and operated Cornerstone Family Health Clinic (Clinic). Respondent is the only governing party for this limited liability corporation.
1.3 Between approximately 2009 and 2010, Respondent’s Clinic submitted approximately eighty (80) Health Care Financing Administration 1500 (HCFA 1500) forms to Premera Blue Cross (hereafter referred to as “Insurance Company”) which misrepresented the rendering provider, including but not limited to the following:
- Between approximately 2009 and 2010, Respondent’s Clinic billed Insurance Company for care provided to Patient A through Patient E as rendered by naturopathic doctor RHC (hereafter referred to as “Dr. RHC”).
- Dr. RHC had previously worked at Respondent’s Clinic between 2006 and 2007; however, Dr. RHC was not employed at Respondent’s Clinic between 2009 and 2010.
- Although Dr. RHC was not employed at Respondent’s Clinic during the period in question, Respondent’s Clinic continued to identify Dr. RHC as a provider on handwritten documents filled out by Respondent and submitted to Insurance Company in 2008 and 2011.
1.4 Between approximately February 2009 and April 2009, Respondent’s Clinic submitted at least six (6) HCFA 1500 forms to Insurance Company for care rendered by Respondent to Patient C and either failed to retain the medical records for these patient visits or failed to actually provide the billed for care.
1.5 Between approximately June 2009 and June 2010, Respondent’s Clinic submitted at least twenty-five (25) HCFA 1500 forms to Insurance Company for care rendered to Patient C by Dr. RHC or Respondent; however, Patient C’s medical records indicated the provider was licensed mental health counselor TC. Respondent’s Clinic failed to maintain retention of the medical records for these patient visits.
1.6 Respondent either failed to adequately supervise acupuncturist TJ or allowed TJ to practice outside the scope of an acupuncturist. Specifically, on approximately nine (9) occasions between approximately November 2009 and July 2010, acupuncturist TJ was the provider identified in Patient C’s medical records who provided diagnosis and treatment of lower back pain with hot and cold treatment to Patient C. This treatment was submitted to Insurance Company with the rendering provider being identified as Dr. RHC.
1.7 Respondent interfered with the Board’s investigation. Specifically:
- Respondent submitted copies of Patient C’s medical records which had a different provider identified than the medical records he had previously submitted to Insurance Company. Patient C’s medical records were altered from identifying Dr. RHC to acupuncturist TJ.
- Respondent provided misleading answers to investigators in answers to letters of cooperation such as his September 19, 2013 response to Department of Health Investigator Michael Friebel.
1.8 Between approximately November 2013 and March 2014, Respondent’s Clinic billed Regence Insurance Company for care provided to patients as being rendered by naturopathic doctor JD (hereafter referred to as “Dr. JD”). Dr. JD was not affiliated with Respondent’s Clinic during the period in question. The claim submissions included Dr. JD’s tax identification number.
1.9 Between approximately January 7, 2014 and March 2014, Respondent’s Clinic submitted at least forty (40) HCFA 1500 forms to Insurance Company for care provided to patients as rendered by naturopathic doctor JB (hereafter referred to as “Dr. JB”). The claim submissions included Dr JB’s national provider identifier (NPI) number and tax identification number. Dr. JB was not affiliated with Respondent’s Clinic during the period in question. Dr. JB had previously worked at Respondent’s Clinic between approximately January 2013 and late December 2013. Dr. JB had moved to California by January 6, 2014.
1.10 Respondent’s Clinic received payment from Insurance Company for the care described in Paragraph 1.9. Dr. JB did not sign the checks from Insurance Company. An unknown third party signed the checks as Dr. JB and then endorsed them to Respondent’s Clinic.
1.11 When questioned by the insurance companies about the original claim submissions identified in Paragraph 1.9, Respondent attempted to submit “Corrected” forms acknowledging that he, not the originally listed naturopath, had been the actual rendering provider.
1.12 On or about April 14, 2015, Respondent was criminally charged in the Superior Court of the State of Washington, King County, Case No. 15-1-02184-9, with:
- One (1) count of Identity Theft in the First Degree, a class B felony;
- One (1) count of Identity Theft in the Second Degree, a class C felony; and
- Two (2) counts of Fraudulent Insurance Claim, a class C felony.
1.13 On or about June 22, 2015, Respondent plead guilty to two (2) counts of Fraudulent Insurance Claim, a class C felony in King County Superior Court, Case No. 15-1-02184-9.
2. ALLEGED VIOLATIONS
2.1 Based on the Alleged Facts, Respondent has committed unprofessional conduct in violation of RCW 18.130.180(1), (4), (7), (10), (13), (14), and (22), and RCW 48.80.030(3), which provide:
RCW 18.130.180. Unprofessional conduct. The following conduct, acts, or conditions constitute unprofessional conduct for any license holder under the jurisdiction of this chapter:
(1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person’s profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. Upon such a conviction, however, the judgment and sentence is conclusive evidence at the ensuing disciplinary hearing of the guilt of the license holder of the crime described in the indictment or information, and of the person’s violation of the statute on which it is based. For the purposes of this section, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for the conviction and all proceedings in which the sentence has been deferred or suspended. Nothing’ in this section abrogates rights guaranteed under chapter 9.96A RCW;
(4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. The use of a nontraditional treatment by itself shall not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;
(7) Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;
(10) Aiding or abetting an unlicensed person to practice when a license is required;
(13) Misrepresentation or fraud in any aspect of the conduct of the business or profession;
(14) Failure to adequately supervise auxiliary staff to the extent that the consumer’s health or safety is at risk;
(22) Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative, or by the use of threats or harassment against any. patient or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal action, or by the use of financial inducements to any patient or witness to prevent or attempt to prevent him or her-from providing evidence in a disciplinary proceeding;
RCW 48.80.030 Making false claims, concealing information – Penalty – Exclusions.
(3) No person shall knowingly make a false statement or false representation of a material fact to a health care payer for use in determining rights to a health care payment. Each claim that violates this subsection shall constitute a separate violation.
2.2 The above violations provide grounds for imposing sanctions under RCW 18.130.160.
3. NOTICE TO RESPONDENT
The charges in this document affect the public health, safety and welfare. The executive director of the Board directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline and the imposition of sanctions under Chapter 18.130 RCW.
DATED: July 15, 2015
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
BOARD OF NATUROPATHY
THOMAS F. GRAHAM, #41818
ASSISTANT ATTORNEY GENERAL
This page was revsied on August 12, 2015.