A statement released by the District Attorney's Office in Orange County, California, on Thursday, April 20, 2017, announced the arrest of a husband and wife and at least two dozen affiliated pharmacists and doctors. They were all taken into custody on suspicion of having conspired to have unnecessary diagnostic tests and treatments rendered only to bill their patients workers' compensation insurance for them.
The ringleaders of the group are thought to be a Beverly Hills husband and wife pair, ages 38 and 37 years old respectively. It's believed that their medical facility management company, which ran Monarch Medical Group, One Source Laboratories, and King Medical Management took in as much as $23 million as a result of their deceptive scheme.
Among the procedures that they are alleged to have requested doctors to order, urine tests were the most common. Additionally, doctors would prescribe unnecessary pain medications and creams, the last of which had to be filled at specialized compounding pharmacies. The billing for these tests and medications would then exceed the reasonable allowable amount.
It is estimated that some 13,000 patients and nearly 25 insurance providers were affected by this group's indiscretions between 2011 and 2015. The Insurance Commissioner for the state emphasizes that this case sets an example of unethical medical professionals consumed with tremendous greed.
As for just how unethical the conduct of these medical professionals was, it was determined that doctors readily prescribed certain medicinal creams known to have the potential for having adverse side effects in exchange for a flat fee kickback from the husband and wife team. Those creams, in turn, were marked up as much as 10 times their actual cost, an amount that the couple would then bill workers' compensation insurers for.
If you've been accused of having engaged in insurance fraud or any other type of white collar crime, then an Orange County, California criminal defense attorney can provide guidance in your legal case.
Source: abcnews.go.com, "More than 2 dozen charged in California insurance fraud case," April 20, 2017