Feds: Millions of dollars lost in workers' comp scheme
- Published on 07/09/2015 - 1:25 pm
- Written by Business Journal staff
Two chiropractors and a psychologist were arrested today in connection to an alleged health care fraud scheme connected to clinics in Fresno, Visalia and Bakersfield.
Chiropractor Bahar Gharib-Danesh, 38, of Woodland Hills, was arrested in Los Angeles; Chiropractor Na Young Eoh, 41, of Bakersfield, was arrested in Bakersfield; and clinical psychologist John Terrence, 72, of Marina Del Rey, is expected to voluntarily appear before the U.S. District Court in Fresno within the next 30 days.
According to a recently unsealed federal indictment, Gharib-Danesh was a chiropractor and manager of Los Angeles-based Pain Relief Health Centers, with clinics in Bakersfield, Visalia and Fresno. Gharib-Danesh is accused of instructing her staff to add as many injured body parts for treatment of workers claiming to have an injury in order to generate higher billings.
Treatment plans generally included shock wave therapy, electro stimulation therapy, myo-facial release/massage, physical therapy, chiropractic manipulation, compound creams and psychological evaluation.
Nearly every patient was scheduled for the same treatments, and the maximum amount of treatments allowed by law was generally billed to the insurance company, according to the U.S. Attorney's office.
Eoh operated out of the Central Valley clinics, signing the treatment plans and referral forms, according to the indictment.
If claims were denied by the insurance company, a lien would be filed and the claims would either be litigated before the California Workers' Compensation Appeals Board or be settled through negotiation. The indictment alleges that lien settlements for less than the full claim were acceptable because of the high volume of patients recruited and the large amount of medical fees generated.
The indictment also alleges that Gharib directed Eoh to refer all patients who came to the clinics for a psychological exam by Terrence, regardless of the patient's injury. The indictment alleges that the bills and reports Terrence submitted for each patient were virtually identical.
It also alleges that Terrence provided each patient with about 20.8 hours of evaluations in a single day, and on one day bill a total of 291.2 hours for treating 14 patients.
Between 2005 and 2012, Terrence submitted claims for psychological services in worker's compensation cases totaling more than $5.6 million, according to the indictment.
If convicted, each defendant faces a possible maximum statutory penalty of 20 years in prison and a $250,000 fine on each count of the indictment.