Man Banned From California’s Workers’ Comp System Charged for Billing Nearly $100M
Man Banned From California’s Workers’ Comp System Charged for Billing Nearly $100M
A man banned for life from the California workers’ compensation system after being twice convicted of fraud was charged with billing nearly $100 million as part of an extensive workers’ comp fraud scheme.
D. F. was charged along with a San Diego-based neurosurgeon and two other co-conspirators in connection with the scheme.
The charges follow a three-year investigation by the Orange County District Attorney’s Office into F., who is accused of continuing to control clinics and providers who would see patients, refer them to specific providers to receive illegal referral payments and then unlawfully bill workers’ comp insurers.
F., 55 of L. N., M. B., 78 of Los Angeles, and R.L., 61 of R.M., formed S., a management company that offered medical management services.
The codefendants, along with San Diego neurosurgeon Dr. V. T., also created a medical group called I. W. M. G., the main client for S., Dr. T. was named the owner and CEO of the medical professional corporation.
Using the medical group, S. reportedly controlled patient referrals to a limited network of providers that contracted with S. to pay for the patient referrals. In three years, the defendants reportedly billed nearly $100 million dollars to numerous workers’ comp carriers, and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.
The four were charged with 13 separate felony counts, which include violations of Labor Code 3215 (referral of clients for compensation), Penal Code 182(a)(1) (conspiracy to commit a crime), Penal Code 549 (false and fraudulent claim) and Penal Code 550(b)(3) (insurance fraud).
If convicted, F. faces a maximum sentence of 18 years and four months in prison. B. faces a maximum of 12 years and four months in prison, T. faces 13 years, four months in state prison and L. faces 12 years and four months in prison.
Deputy District Attorney K. A. of the Insurance Fraud Unit is prosecuting the case.
Kaynak: https://www.insurancejournal.com/magazines/mag-features/2024/11/04/799548.htm