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D.C. Caught Creating False Impairment Ratings With Forged Radiologist Report
Yellow Pages
Written by TAC Staff: Yellow Pages   
Friday, 25 January 2013 04:35
aroundtheworldLOS ANGELES, CA -- Los Angeles County Superior Court is awarding Allstate Insurance Company more than $7 million in a qui tam action filed by the insurer on its behalf and on behalf of the People of the State of California against a Long Beach chiropractor, Daniel H. Dahan, D.C., and his business, Progressive Diagnostic Imaging, Inc., arising out of a scheme to defraud insurance companies.
 
In the judgment, Superior Court Judge Ernest M. Hiroshige found that Dahan and Progressive Diagnostic Imaging violated the state's Insurance Frauds Prevention Act in 487 claims presented to Allstate in radiology reports that were determined to be "falsified medical records" that "have no diagnostic, clinical, or medical value whatsoever." Hiroshige further concluded that health insurance claim forms and billing statements submitted in connection with the falsified radiology reports were "false and fraudulent."
 
The judge ordered that Dahan pay Allstate $4,870,000 in civil penalties, $918,516.78 in assessments and $1,222,151.62 in attorney's fees, costs and investigative expenses--$7,010,668.40 in all.
 
Allstate alleged that Dahan purchased report-writing software that purported to analyze x-rays and form medical opinions and diagnoses, including opinions concerning permanent impairment ratings, and thereafter formed Progressive Diagnostic Imaging to solicit x-rays from chiropractors, with the assurance that "board certified radiologists" would analyze the films.
 
Allstate further claimed that, unbeknownst to patients and health care providers using Progressive Diagnostic Imaging, Dahan recruited untrained and unlicensed individuals to work with the report-writing software to prepare the fraudulent radiology reports. To make it appear that the reports were genuine, Dahan instructed his "technicians" to cut and paste the signatures of board certified radiologists to the reports, all without the knowledge, approval or authorization of the radiologists. The reports and bills were presented to Allstate in support of claims, either directly by Dahan and Progressive Diagnostic Imaging or by plaintiff attorneys in auto accident cases.
 
At trial, four radiologists, whose names appeared on reports, testified they never wrote, reviewed, approved or signed the reports.
 
Beyond the verdict, Hiroshige also issued an injunction prohibiting Dahan from owning, operating or working as an employee in any business engaged in the practice of medicine. And he ordered that letters be sent to all of the affected patients and their referring healthcare providers, to advise them of the Court's findings and judgment, including the Court's order that the reports generated by Dahan and Progressive Diagnostic Imaging are "to be disregarded on the basis that such reports [are] . . . falsified medical record[s]" and have "no diagnostic, clinical or medical value whatsoever," and that "records are not to be considered by any person or entity as part of the . . . patient's medical history, medical record, or medical chart at any time and for any purpose."

Source:  Allstate Corporation
 
Colorado, Washington Legalize Recreational Marijuana Use
Yellow Pages
Written by TAC Staff: Yellow Pages   
Monday, 24 December 2012 09:17
aroundtheworld
The same day President Barack Obama was re-elected for his second term, Colorado and Washington became the first two states in the country to legalize recreational marijuana use and possession for people over the age of 21.
 
Voters approved the Colorado Marijuana Legalization Amendment, also known as Amendment 64, while the Washington Marijuana Legalization and Regulation, Initiative 502, was passed in Washington marking the first time recreational marijuana legislation was passed. 
 
Amendment 64 lists many restrictions in marijuana use including it being “taxed in a manner similar to alcohol.” Similarly to alcohol, customers are required to present a photo ID when purchasing marijuana.
 
Those of the legal age will be allowed to purchase up to one ounce of the drug from retail stores and grow up to six marijuana plants in their homes. However selling, distributing and transferring marijuana to minors, driving under the influence and using marijuana in public remains illegal.
 
Initiative 502 proposes a 25 percent tax imposed when the grower sells marijuana to a processor, again when the processor sells it to a retailer and a third time when the retailer sells it to a customer. 

Source: The Review
 
PI Chiropractor Convicted of Insurance Fraud
Yellow Pages
Written by TAC Staff: Yellow Pages   
Monday, 24 December 2012 09:12
aroundtheworld
CHESTERFIELD, MO Dr. Anthony Calandro, a Chesterfield resident, and owner of the Chiropractic Accident Centre of Crestwood  was convicted Nov. 8 of billing insurance companies for X-rays never taken and for appointments that the patients had canceled or missed. His billing assistant Sherry Rueter previously pled guilty to related charges.
 
According to testimony presented at trial, during 2010 and 2011, two undercover investigations revealed that Dr. Calandro and Ms. Rueter billed multiple insurance companies for services that were never rendered. From 2006 to 2011, they submitted numerous reimbursement claims that falsely stated that the Chiropractic Centre had taken more X-rays than were actually taken. In most instances, only one or two X-rays were taken during a patient’s visit, but many more X-ray views were billed. Since health insurance companies would not reimburse Chiropractic Centre if a claim indicated the patient had missed an appointment and had not received a billable service, they falsely indicated that a billable service had been provided to patients. Using false codes, they submitted thousands of false claims for missed appointments.
 
Calandro and Chiropractic Accident Centre of Crestwood PC were convicted of one felony count of health care fraud. Dr. Calandro was also convicted of three counts of making false statements related to health care services; the corporation was convicted of four counts of making false statements. The four-day trial was held before United States District Judge E. Richard Webber. Sentencing for Dr. Calandro is scheduled for Feb. 7, 2013.
 
Co-defendant Sherry Rueter, St. Louis, Missouri, pled guilty in October to four felony counts of making false statements related to health care services and is scheduled for sentencing Jan. 24, 2013.
 
Each count of health care fraud carries a maximum penalty of 10 years in prison and/or fines up to $250,000; each count of making false statements carries a maximum of five years in prison and/or fines up to $250,000. The corporation faces maximum fines up to $500,000 per count. In determining the actual sentences, a judge is required to consider the U.S. Sentencing Guidelines, which provide recommended sentencing ranges.
 
Additionally, the defendants are subject to forfeiture to the government of all money derived from their illegal activity.
 
This case was investigated by the Federal Bureau of Investigation. Assistant United States Attorneys Dorothy McMurtry and Dianna Collins prosecuted the case for the U.S. Attorney’s Office.
 
 
 
Chiropractor Cracks, Pleads Guilty to Insurance Fraud for Third Time in a Decade
Yellow Pages
Written by TAC Staff: Yellow Pages   
Monday, 24 December 2012 08:53
aroundtheworld
Ridgewood, NJ: Prosecutors say Craig Klein, of Ridgewood, filed misleading and faulty personal injury claims to auto insurers. He has previous convictions for insurance fraud. A former chiropractor has admitted guilt in running an auto insurance fraud scheme for the third time in a decade, Passaic County Prosecutor Camelia M. Valdes announced Wednesday.
 
According to prosecutors, Craig Klein, 46, of Ridgewood, paid "runners" to steer accident victims to Hamilton Rehabilitation Center in Paterson and then submitted over 30 fraudulent personal injury claims to automobile insurers from Dec. 2010 and Feb. 2011.
 
Klein, a co-owner, shared in the profits from the faulty claims, receiving between $500 and $75,000, Valdes said.
 
He has previous convictions for similar schemes in 2003 in Essex County and in Massachusetts in 2008. The state suspended his license to practice in 2005. Klein admitted guilt in providing false information to insurance companies that his downtown Paterson office was actually legitimate, Valdes said.
 
Prosecutors allege the chiropractic business – billed as a treatment center for those injured in auto accidents – was anything but.
 
"He knew that non-chiropractors had an illegal disguised ownership interest in the facility and that the facility paid runners for illegal referrals," Valdes said in a written statement.
 
Three other employees of Hamilton Rehabilitation Center were also indicted for their alleged roles in the scheme, according to prosecutors.
 
Klein pleaded guilty to a charge of theft by deception, a third degree charge that could land him behind bars for five years.
 
The investigation took over a year and remains ongoing, Valdes said.
 
Source: Ridgewood-Glenrock Patch
 
 
Chiropractor Pleads Guilty to Fraud
Yellow Pages
Written by TAC Staff: Yellow Pages   
Sunday, 25 November 2012 22:15
aroundtheworld
LAFAYETTE, LA-A Lafayette chiropractor has pleaded guilty to federal health care fraud charges for billing an insurance company for more than $170,000 in treatments that were not done.

The Advocate reports (http://bit.ly/R7XNg9) Michael Keith Johnsey, of Acadiana Doctors of Chiropractic in Lafayette, faces up to 10 years in prison on three counts of health care fraud in connection with hundreds of fraudulent billings to Blue Cross Blue Shield of Louisiana between 2008 and 2011.

Prosecutors also sought $176,243 in restitution.

Johnsey brought a check for the entire amount to the court hearing Thursday.

"He has been a model citizen and a good man," said Johnsey's attorney, Thomas Guilbeau. "He made a mistake and he is stepping up to pay restitution. ... He will do whatever he can to restore his name."
 
Source: Goerie.com
 
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