PENNSYLVANIA: Dr. Joseph J. Lerner, 50, of Chalfont, PA, was sentenced in early January to 36 months in prison for a $3 million scheme to defraud Independence Blue Cross, Aetna Health Management, Highmark Blue Shield and five other health insurance companies.
According to charges brought by the U.S. Attorney’s Office, Lerner, a chiropractor who owned a gym and health club in Horsham, PA, fraudulently billed the insurance companies for chiropractic treatments that Lerner neither provided nor supervised between 2007 and March 2010.
Lerner hired masseuses and personal trainers to work at Horsham Fitness, to provide massages and personal training to gym members whose health insurance Lerner would bill fraudulently for chiropractic services that Lerner never provided, according to the U.S. Attorney’s Office.
Lerner suggested to people seeking to join the gym that they could obtain massages and personal training for the very low price of only a co-payment, usually $10, by having their health insurance pay for those massages and personal training sessions.
The U.S. Attorney alleged that Lerner caused the submission of fraudulent medical bills to the eight insurance companies totaling about $3 million, resulting in payments from the insurers of more than $1.9 million.
In addition to the prison term, U.S. District Court Judge Cynthia M. Rufe ordered Lerner to pay restitution in the amount of $1,932,910.95 to the insurance companies. The government seized cash and bank accounts from Lerner totaling $432,834.12.
Philadelphia Business Journal