4 Get Prison Time (with More Likely to Come) in Massive Unity Medical Billing Fraud Scheme
The $154 million medical fraud case in Orange County Superior Court is so massive that some charges against defendants--even those who have already been convicted and sentenced--will have to be tried at later times. Besides fraud counts tied to recruiting more than 255 healthy patients to undergo unnecessary and dangerous surgeries at since-closed Unity so medical insurance companies could be fraudulently billed, some defendants face charges of failing to file tax returns and under-reporting income to state tax authorities. Future trial dates have yet to be set.
4 More Go Down in $154 Million Medical Billing Fraud Prosecution
We can report that Judge Thomas Goethals on Thursday sentenced:
- Roy Chester Dickson, 64, Yorba Linda, Unity's attorney, to two years and eight months in state prison and $41,629 restitution. A jury last month convicted him on two felony counts of filing a false personal tax return. He faces 101 additional felony counts for crimes ranging from conspiracy to capping (paying for referrals), grand theft, insurance fraud, making false and fraudulent claims, money laundering and white collar sentencing enhancements for taking over $2.5 million on the fraud counts.
- Andrew Robert Harnen, 58, Rosemead, Unity's accountant, got
five years and four months in state prison and $904,780 in restitution. He
was found guilty in November of three felony counts of
filing a false tax return and six counts of failing to file tax returns.
He also faces 101 additional felony counts.
- Dee Francis, 63, a Unity administrator, was sentenced to six years in state prison and $905,507 restitution. She was found guilty in November of one felony count of filing a false tax return and six counts of failing to file tax returns. She faces 102 additional felony counts.
- Rosalinda Rodriguez Landon, 66, a Unity administrator, was sentenced to five years and four months in state prison and $1,104,496 restitution. She was found guilty in November of six felony counts of filing false tax returns and faces 101 additional felony counts.
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.
Pancha Keophimone, Recruiter of Patients in $154 Million Insurance Scam, Cuts a Deal
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.
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