4 More Go Down in $154 Million Medical Billing Fraud Prosecution

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An attorney, an accountant and two administrators were convicted today for their roles in a $154 million medical fraud and the largest such prosecution in the nation, according to the Orange County District Attorney's office (OCDA). The defendants, who are scheduled to be sentenced on these convictions on Dec. 20 but still have other fraud charges pending against them, recruited more than 255 healthy patients to undergo unnecessary and dangerous surgeries at a since-closed Buena Park facility so medical insurance companies could be fraudulently billed.

See also:
Pancha Keophimone, Recruiter of Patients in $154 Million Insurance Scam, Cuts a Deal
Dr. Sim Carlisle Hoffman Slapped with 833 Fraud Counts for Being Alleged "Medical Mill Mastermind"
Allied Management Group Special Investigation Unit of Santa Ana Accused of Being Sham Health Care Fraud Finders

The Orange County Superior Court case, which also involves charges of failing to file tax returns and under-reporting income to state tax authorities, was so involved, voluminous and defendant-heavy that the Santa Ana court bifurcated it. Another trial date is to be set on additional counts.

All the defendants were tied to Unity Outpatient Surgery Center, the Buena Park facility that has since shut its doors. An investigation by the OCDA, the California Franchise Tax Board and the California Department of Insurance revealed the scammers recruited 2,841 healthy people from all over the country to receive unnecessary surgeries in exchange for money or low cost cosmetic surgery. Insurance companies paid out more than $20 million over a nine-month period.

Of the 19 defendants charged in the Unity case, 13 were indicted by the Orange County grand jury on June 13, 2008. Six other defendants in the Unity case pleaded guilty before indictment and have been sentenced. The grand jury examined 1,054 exhibits and heard testimony from 56 witnesses over 28 days, resulting in a 70-page indictment.

An attorney, accountant, three doctors, and patient recruiters were accused in the indictment of acting as "cappers," who recruit patients despite the practice being illegal in California. Several have pleaded guilty to multiple "capping" counts.

Despite having no medical training, the cappers targeted more than 1,000 employees from businesses in 39 states who were covered by PPO insurance plans, arranging transportation to Unity, scheduling surgeries and coaching healthy "patients" on what to say. In exchange for undergoing surgery, the patients received payments of $300 and $1,000 a pop or credit toward a free or discounted cosmetic surgery.

Three doctors charged in this case are accused of participating in medical insurance fraud for performing unnecessary medical procedures on healthy people with the knowledge that the patients were being recruited, performing 1,037 procedures that resulted in insurance billings exceeding $30 million for the facilities fees alone. Unity received more than $5.1 million in payment as a result of the surgeries performed by these doctors.

Unity's medical director performed unnecessary surgeries on 161 patients including laproscopy, tubaligation, colporrhaphy and hysterectomy procedures. None of his patients were referred by doctors or faced medically necessary procedures. Another surgeon, who generally performed sweaty palm surgeries that are highly unusual and dangerous medical procedures, was also indicted and convicted by the federal government for his involvement in a scheme similar to the Unity case.

The attorney Unity relied on had previously managed and represented another surgery center involved in similar illegal activities and had been sanctioned by the federal bankruptcy court for filing a fraudulent bankruptcy claim for a doctor at that surgery center. After the OCDA searched Unity in April 2003, the attorney used a client trust account to keep the center open and operating, funneled more than $1 million in Unity cash assets into his account to prevent it from being seized and in the next three months laundered as much as $3 million into the attorney client trust account using fraudulently billed payments from insurance companies to keep the surgery center operating.

The accountant signed fraudulent paychecks, hid assets and income, helped recruit patients and failed to report more than $6 million in income over a three-year period by failing to file tax returns and filing false tax returns.

Administrators recruited doctors and cappers, coordinated the phony surgeries and received fraudulent billings and invoices to pay cappers.

The identities of the defendants and the status of their cases follow on the next page . . .

Unity attorney Roy Chester Dickson, 64, of Yorba Linda, was found guilty by a jury of two felony counts of filing a false personal tax return and faces a maximum sentence of three years and eight months in state prison. Dickson also faces 101 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of money laundering, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts. A trial date for these counts has not yet been set.

Unity accountant Andrew Robert Harnen, 58, of Rosemead, was found guilty by a jury of three felony counts of filing a false tax return and six counts of failing to file tax returns. He faces a maximum sentence of eight years and four months in state prison--as well as a separate trial and more potential time for 101 additional felony counts that include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of filing a false tax return, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts.

Administrator Dee Francis, 63, was found guilty by a jury of one felony count of filing a false tax return and six counts of failing to file tax returns. She faces a maximum sentence of seven years in state prison--as well as 102 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of filing a false tax return, two counts of failing to file tax returns, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts.

Rosalinda Rodriguez Landon, 66, another Unity administrator, was found guilty by a jury of six felony counts of filing false tax returns and faces a maximum sentence of six years and four months in state prison for these counts. Landon faces 101 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of money laundering, and white collar sentencing enhancements for taking over $2.5 million dollars.

On Dec. 27, 2005, administrators Tam Vu Pham, 48; Huong Thien Ngo, 46; and Lan Thi Ngoc Nguyen, 56, pleaded guilty to a laundry list of felony counts including conspiracy, money laundering, capping, making false or fraudulent claims and insurance fraud, while various sentencing enhancements were found true. All were ordered to pay restitution, and Pham was sentenced to 12 years, Ngo to seven years and Nguyen to five years in state prison. They were to follow their incarcerations with probation.

Doctor William Wilson Hampton Jr., 57, of Seal Beach, pleaded guilty May 8, 2009, to 47 felony counts including conspiracy, insurance fraud, and capping and was sentenced to 16 years in state prison.

Doctor Michael Cheeluen Chan, 66, of Cerritos, pleaded guilty Aug. 4, 2011, to 40 felony counts including conspiracy to commit insurance fraud, insurance fraud, aiding and abetting capping with white collar crime sentencing enhancements. He faces a sentence ranging from probation up to 28 years in state prison at his Dec. 7 sentencing in Santa Ana.

Doctor Mario Rosenberg, 65, is charged with 49 felony counts including two counts of conspiracy, eight counts of capping or paying for referrals, 19 counts of insurance fraud, 19 counts of making false or fraudulent claims, and one count of grand theft. He has a pre-trial hearing scheduled Dec. 21.

The remaining defendants are cappers. Sue Nanda, 44, of Costa Mesa, pleaded guilty Feb. 20, 2009, to 22 felony counts including conspiracy, capping, grand theft, filing false tax returns, failing to file tax returns, and making false and fraudulent statements. She was sentenced to 10 years in state prison and ordered to pay more than $500,000 in restitution for personal and corporate back taxes.

Maria DeJesus Licea Rosales, 45, pleaded guilty Aug. 7, 2009, to 96 felony counts including conspiracy, capping, insurance fraud, grand theft, filing fraudulent tax returns, and sentencing enhancements for white collar crime and loss over $2.5 million. She was sentenced to eight years in state prison.

Olga Lilia Toscano, 44, pleaded guilty Aug. 11, 2009, to 98 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. She was sentenced to eight years in state prison.

Ngoc Trang Huynh, 52, pleaded guilty Aug. 19, 2011, to 56 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, filing a false income tax return, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. He faces up to 45 years and eight months in state prison at his Dec. 7 sentencing.

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Pancha Keophimphone
Pancha Keophimphone, 61, pleaded guilty to a court offer Aug. 19, 2011, to 56 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. She was sentenced to 12 years in state prison stayed pending completion of five years formal probation. She was ordered to serve one year in jail and has a Dec. 7 hearing where her restitution amount will be set.

Thuy Thu Huynh, 54, pleaded guilty Aug. 25, 2011, to 58 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. Huynh is to be sentenced Dec. 7.

Henry Truong, 44, pleaded guilty April 7, 2006, to 13 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. He was sentenced to 12 years in state prison and ordered to pay restitution.

Finally, Amanda Phuc Tran, 53, and Nicholas Vu, 54, pleaded guilty Nov. 21, 2005, to two felony counts each of insurance fraud and making false or fraudulent claims with sentencing enhancements for loss exceeding $2.5 million. They were each sentenced to five years in prison stayed pending completion of 10 years formal probation. They were also ordered to pay restitution.

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2 comments
crystalvoxxusa
crystalvoxxusa

Medical fraud is one of the commonest things which happen across all states and cities. But to overcome them with a penaly by the jurisidication system is of utmost importance which has been shown here. This helps in better healthcare system management of services..

OCWeekly
OCWeekly

@JohnStandish136 Gracias for RT!

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