This morning, federal prosecutors launched a multistate series of raids, arresting 73 people in conjunction with what may turn out to be the largest medical care fraud scheme in history of the United States — including many arrests here for health care fraud and insurance fraud in Los Angeles and throughout the Southland for Los Angeles health care fraud.
Before we dive into this story–which will surely occupy media outlets for some time–let’s first review some examples of state insurance fraud and medical insurance fraud so you can understand Los Angeles white collar crime better:
* Chiropractor in Glendale bills an insurer for work he never did.
* Dentist in Pasadena orders completely unnecessary tests for a patient for the explicit purpose of pocketing insurance money.
* Family doctor in Beverly Hills works with associates to falsify medical records of patients to get extra money from an insurer.
Anyone who is in the pre-filing stage for Los Angeles medical insurance fraud can be at serious risk for massive fines, a prison sentence, and other serious penalties.
Now that you have some background in state insurance fraud law, let’s turn our attention to the details of this massive bust.
United States Attorney Preet Bharara revealed that a veritable army of Armenian gangsters allegedly bilked Medicare out of $163 million — a coordinated criminal effort that “put the traditional Mafia to shame.”
The scope of the alleged insurance fraud is breathtaking. Federal authorities initiated an investigation after thousands of Medicare patient and doctor records were reported stolen — these records included patients’ dates of birth and Social Security numbers. The medical billing fraud network (and associates) set up fake clinics in 25 states — 118 fake clinics, all told — to bill Medicare for providing (non-existent) services.
The FBI described these clinics as “completely notional” — that is, they didn’t actually exist. The doctor-patient interactions at these clinics were apparently a “mirage.” Prosecutors highlighted some examples:
* eye doctors supposedly billing for bladder tests
* delivery room doctors ordering up skin allergy tests
According to the US attorney, the Los Angeles health care fraud network had been operating under the guidance of Armen Kazarian, the Armenian equivalent of a Mafia godfather. Kazarian — as of this writing — is being held at a Los Angeles jail.
In addition to the Southern California medical billing fraud arrests, police have detained people in New York, Mexico, Georgia, and Ohio. Kazarian and the 72 others are scheduled to be arraigned this afternoon on these charges, which will include: identity theft, money laundering, racketeering conspiracy, and bank fraud.
Insurance fraud in Southern California is a serious crime — whether you’re a chiropractor, dentist, doctor, or other caregiver. If you’re in the pre-filing stages, you should be aware of the potential ramifications of conviction, which can include:
* the loss of your professional license
* a lengthy prison sentence
* serious court costs and fines
* mandatory restitution to insurance agencies
* loss of ability to provide Medicare or Medi-Cal services in the future
Doctor, dentist, and chiropractor insurance fraud in Los Angeles can be charged pursuant to a variety of laws, depending on what prosecutors allege you did. These laws include Insurance Code Section 1871.4, Penal Code Section 550, Penal Code Section 118, and Labor Code Section 3700.
What specifically constitutes Southern California health care fraud? Here are some examples:
* creating false medical records
* billing twice for chiropractic, dental, or other medical work
* ordering unnecessary medications
* billing Medicare or another program for work not provided
* requesting unnecessary tests for patients
If you are in the pre-filing stage of a federal or Southern California medical billing fraud case, it’s essential to discuss your situation with a credentialed Southern California health care fraud lawyer. Whether you’ve been hit with insurance fraud in Glendale or chiropractic fraud in Pasadena, you need to understand your rights and responsibilities under the law.
Michael Kraut of Los Angeles’ Kraut Criminal & DUI Lawyers can help. Attorney Kraut served for 14+ years as a fraud prosecutor. He understands how law-enforcement agents and prosecutors will put together your insurance fraud case, and he knows how to break down their case and ensure that you get the best possible protection.