The Western District of Louisiana obtained a $2.1 million judgment against a Shreveport chiropractor. The Louisiana Department of Health and Hospitals performed an audit of Medicaid reimbursements which revealed 86% of his patients were minors, and often members of the same family. The audit also revealed that billed services were not actually provided or were upcoded. (1997)
A chiropractor, with high billing rates, and his wife were convicted of numerous counts of mail fraud involving the padding of bills in the treatment of victims of automobile accidents. Their scheme had two principal components: the making of fraudulent disability findings for potential plaintiffs in auto accidents and in workers’ compensation claims, and performing fraudulently excessive testing and treatment of such individuals, often in order to raise the cost of the medical care provided to an accident victim above the dollar threshold set forth in Massachusetts’ no-fault statute. The chiropractor was sentenced to a fifteen-month prison term, fined more than $300,000 and ordered to pay more than $136,000 in restitution. The Court sentenced his wife to three years of probation. (1997)
In a case investigated by the FBI, the FDA, the State of Idaho Attorney General’s Office, the Idaho Bureau of Narcotics and the U.S. Attorney’s Office for the District of Idaho, an indictment was returned in October, 1995, which resulted in the successful prosecution of a naturopath for mail fraud and mislabeling a controlled substance. The mail fraud charges relate to the naturopath’s practice of billing insurance companies through a licensed chiropractor, who was employed at the naturopath’s clinic, for an unapproved and experimental blood test performed entirely by the naturopath. The naturopath obtained over $50,000 in one year billing patients and insurance companies for the experimental test. The mislabeling charges related to “black pearls” sold to patients which contained Valium. As a part of the plea agreement the defendant has agreed to stop practicing as a naturopath. On March 19, 1996, the defendant was placed on four years probation, ordered to pay $1,186 restitution and fined $10,000.
On April 23, 1997, in the District of Massachusetts, a chiropractor pleaded not guilty to charges of insurance fraud, larceny, and conspiracy. Along with five other defendants, the chiropractor was charged with submitting false claims derived from staged accident and injury schemes to insurance companies. Prosecutors allege that they deliberately neglected to inform insurance carriers of previous accidents, similar injuries, and prior treatments. Seven insurance companies were allegedly defrauded out of more than $78,000.
On April 25, 1997, in the Northern District of Texas, a chiropractor was sentenced to 21 months in prison and ordered to pay $37,891 in restitution for defrauding two insurance companies. The defendant, with the help of a patient, falsified patient records, submitted false insurance claims for treatments not received, and split the proceeds. Both men pleaded guilty to one count of mail fraud, and the doctor agreed never to practice medicine again.
On August 19, 1998, in the District of South Carolina, a man was sentenced to two months in prison and ordered to pay $40,874 in restitution for mail fraud and for aiding and abetting a chiropractor who defrauded insurance companies by filing bills for unnecessary tests. The man aided the scheme of a doctor, the former owner and operator of the Plemmons Clinics. From 1992 to 1994, the doctor filed $2 million in billings for unnecessary nerve and vascular tests that he performed on family, friends, and patients. For seven months in 1994, the man that aided the doctor signed the bills for unnecessary testing that the doctor sent to insurance companies. In June 1998, the doctor was sentenced to 46 months in prison and ordered to pay more than $1 million in restitution for the actual payments he received from the insurance companies.
On September 21, 1998, in the Western District of Washington, a Tacoma chiropractor pleaded guilty to a felony charge of mail fraud. The chiropractor, doing business at ACTS Chiropractic Center, caused chiropractic records to be falsified to indicate that progress examinations were conducted on a different day from the date of an examination, so he could bill for two services which had actually occurred during a single office visit. During 1994 and 1995, when some of the falsely billed office visits were rejected, the chiropractor falsely billed for spinal manipulations on these dates when no services were provided. The fraudulent bills were processed by King County Medical, predecessor of Regence Blue Shield, while acting as a third party administrator of the Boeing Medical Plan. The chiropractor will pay an agreed restitution of $19,038 to Regence for the Boeing Plan.
This article was posted on August 23, 1999.
