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OCDASeal

Orange County District Attorney
Press Release


Tony Rackauckas, District Attorney
401 Civic Center Drive West
Santa Ana, CA 92701

For Immediate Release



 


February 4, 2009

Contacts:

Susan Kang Schroeder
Public Affairs Counsel
Office: 714-347-8408
Cell: 714-292-2718

Farrah Emami
Spokesperson
Office: 714-347-8405
Cell: 714-323-4486

OCDA CHARGES CHIROPRACTORS, ATTORNEY, AND OFFICE EMPLOYEES IN SWEEP OF ILLEGAL REFERRAL AND/OR OVERBILLING SCHEME

 

SANTA ANA – The OCDA has arrested and charged 12 defendants, including chiropractors, an attorney, and office employees in an undercover sting operation targeting illegal patient referral and insurance overbilling schemes. Operation K-Fraud (Knockout Fraudulent Attorneys and Unscrupulous Doctors) was an undercover operation coordinated and conducted by the Orange County District Attorney’s (OCDA) Insurance Fraud Unit and Gatekeepers Insurance Fraud Team (GIFT). GIFT investigates provider professionals suspected of defrauding auto and Workers’ Compensation Insurance companies through undercover operations.

 

Based on a list compiled by the National Insurance Crime Bureau, the OCDA sent 248 letters to medical providers suspected of engaging in fraudulent practices or billing.  The letter explicitly outlined the opportunity for the medical professional to engage in an illegal fee splitting scheme with a fake attorney’s storefront office set up by the OCDA.  The scheme involved medical professionals agreeing to pay up to 30 percent of specific patient billings to the OCDA undercover investigators posing as law office administrators in exchange for that patient’s referral. OCDA undercover investigators also posed as “patients” claiming to be suffering from soft tissue damage from car accidents.

 

Of the 248 letters, 20 individuals responded to inquire about the scheme.  Four of the 20 medical professionals did not show up after scheduling a meeting.  Six others showed up for a meeting, but after meeting with undercover OCDA investigators, they abandoned the scheme, acknowledging it was illegal. The OCDA did not pursue three of the medical providers for other reasons.

 

The OCDA has charged 12 defendants in nine criminal cases including eight chiropractors, one attorney, and three administrative staff members. In the storefront operation, the OCDA charged seven chiropractors and one chiropractic administrator/chiropractor’s wife for engaging in an illegal fee splitting scheme. Two of these eight defendants are also charged with billing for more services than rendered.

 

In addition to the law office storefront undercover investigation, the OCDA also conducted walk-in investigations of chiropractic clinics and law offices, where a chiropractor is accused of making a referral to an attorney and law office administrative staff are accused of making a referral to a chiropractor. In these cases, a chiropractor and an attorney have been charged with overbilling and engaging in an illegal fee splitting kickback schemes in 2005 and 2007. Additionally, the OCDA has charged one law office administrator, a chiropractor, and his chiropractic administrator with engaging in overbilling and an illegal fee splitting kickback scheme.

 

Professionals who file insurance claims, such as medical doctors, chiropractors, and attorneys, are prohibited from paying monetary compensation as a kickback to a patient or to anyone who refers a patient to them for their professional services.  Public policy requires medical and legal professionals to attract patients and clients based on their skills and abilities.  There is no public benefit in having patients medically treated or clients represented by unqualified or unskilled practitioners.  General advertising to make one’s name known is not barred, but the exchange of money for patients is illegal.  Any medical professional or attorney knows or should know through their education and training that such fee splitting is prohibited by law. 

 

For their cooperation and assistance, the OCDA would like to thank the California Department of Insurance, National Insurance Crime Bureau, California State Bar, Cypress Police Department, Garden Grove Police Department, Laguna Beach Police Department, Tustin Police Department, Automobile Club of Southern California, Infinity Insurance, Mercury Insurance, and Sentry Insurance Companies.

 

Senior Deputy District Attorney Jo Escobar and Deputy District Attorney Demetra Lewis of the Insurance Fraud Unit are prosecuting these cases.

 

“When every dollar counts, it matters that your auto insurance and health insurance keep skyrocketing because of fraud,” said Orange County District Attorney Tony Rackauckas. “We obviously cannot catch every crooked chiropractor or amoral attorney, but we hope to send a message that they will be risking their license and freedom by engaging in these types of fraud.”

 

"Insurance fraud is not a victimless crime and costs every man, woman and child in California $500 each year," said Insurance Commissioner Steve Poizner. "Through the good work of the Orange County District Attorney's Office and oftentimes in partnership with Department of Insurance investigators, these alleged scam artists will be brought to justice."

 

DEFENDANTS CHARGED WITH ILLEGAL KICKBACK SCHEME AND OVERBILLING

 

Mark Allen Tichelaar, Chiropractor (storefront case)

 

Case # 09CF0232

Age: 50

Residence: Anaheim

Business Name: Advanced Care Sports Rehabilitation

Business Address: 312 W. Cerritos Avenue, Anaheim

Felony Charges: one count of insurance fraud, one count of grand theft, two counts of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 7 years

Bail: $50,000 - posted

Arrest Date: Feb. 3, 2009

Arraignment Date: March 3, 2009

Department: Central Justice Center, Santa Ana

 

Tam Van Nguyen, Chiropractor (storefront case)

 

Case # 09CF0235

Age: 34

Residence: Westminster

Business Name: Century Chiropractic

Business Address: 13252 Century Boulevard, Ste. L, Garden Grove

Felony Charges: one count of insurance fraud, one count of grand theft, one count of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 6 years 4 months

Bail: $50,000 - posted

Arrest Date: Feb. 3, 2009

Arraignment Date: March 4, 2009

Department: Central Justice Center, Santa Ana

 

Tichelaar, on Feb. 26, 2008, and Nguyen, on Jan. 22, 2008, are accused of going to an undercover OCDA law office storefront with the intent to participate in an illegal patient referral scheme after each received a letter sent by the OCDA, as described above.  Each of these meetings lasted approximately 30 minutes. Each chiropractor is accused of agreeing to pay 30 percent of his insurance company billings to the fake attorney’s office for every patient that the OCDA undercover investigator referred specifically to him. 

 

Between March 18, 2008, and June 4, 2008, an undercover OCDA investigator went to Tichelaar for 14 “treatments” under the pretense of having been involved in a car accident.  Tichelaar is accused of billing the insurance company for 23 “treatments.”  On Nov. 13, 2008, Tichelaar is accused of accepting $2,380 for “treatments”, including the nine he did not render, and illegally kicking back $1,020 to the OCDA undercover investigator.

 

Between April 30, 2008, and July 24, 2008, an undercover OCDA investigator went to Nguyen for seven “treatments” under the pretense of having been involved in a car accident.  Nguyen is accused of billing the insurance company $5,215 for 40 “treatments.”  On Oct. 22, 2008, Nguyen is accused of accepting $3,650 for “treatments” rendered, including the 33 he did not render, and illegally kicking back $1,565 to the OCDA undercover investigator.

 

Florin Catinas, Chiropractor (walk-in case)

 

Case # 09CF0236

Age: 35

Residence: Anaheim

Business Name: rented office at Schwartz Chiropractic

Business Address: 504 S. Brookhurst Avenue, Anaheim

Felony Charges: two counts of insurance fraud, two counts of grand theft, two counts of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 8 years 8 months

Bail: $50,000 – in custody

Arrest Date: Feb. 2, 2009

Arraignment Date: Today, Feb. 4, 2009, at 1:30 p.m.

Department: C-49, Central Justice Center, Santa Ana

David Gonzalez, Attorney (walk-in case)

 

Case # 09CF0236

Age: 45

Residence: Placentia

Business Name: The Law Offices of David Gonzalez

Business Address: 1010 N. Ross Street, Ste. 250, Santa Ana

Felony Charges: two counts of insurance fraud, two counts of grand theft, one count of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 8 years 8 months

Bail: $50,000 - posted

Arrest Date: Feb. 2, 2009

Arraignment Date: March 2, 2009

Department: Central Justice Center, Santa Ana

On July 12, 2005, Catinas is accused of meeting with an OCDA undercover investigator, whom he believed to be a law office administrator, and agreeing to pay for patient referrals. At this meeting, which lasted approximately 30 minutes, Catinas is accused of agreeing to pay 30 percent of his insurance company billings to the fake attorney’s office for every patient that the OCDA undercover investigator referred to him. 

The undercover investigator from the OCDA took a “patient” to Catinas, who went to Catinas seven times for “treatments” between July 19, 2005, and Sept. 7, 2005, under the pretense of having been injured in a car accident. The “patient” was another undercover OCDA investigator. On Oct. 25, 2005, Catinas is accused of overbilling Sentry Insurance Company for 27 visits amounting to $3,658.  Catinas is also accused of referring the “patient” to Gonzalez for “representation.”

Gonzalez is accused of coaching the undercover investigator “patient” to lie to the insurance company about the extent of his injuries and the number of visits made to Catinas.  On Oct. 25, 2005, Gonzalez is accused of sending a letter to Sentry Insurance Company demanding $15,000 for the “patient’s” car accident claim, despite knowing that the claim was overstated and fraudulent. 

Sometime after Feb. 14, 2006, Gonzalez is accused of illegally splitting the $7,500 check mailed from Sentry Insurance Company. He is accused of kicking back $2,625 to Catinas, $2,400 to the OCDA undercover investigator posing as a “patient,” and keeping $2,375 for himself. Gonzalez is also accused of soliciting to pay the same OCDA undercover investigator for new “patient” referrals.  Of the $2,400 that he received, Catinas is accused of kicking back $650 to the OCDA undercover law office storefront for the “patient” referral.

 

On Jan. 24, 2007, the 2005 OCDA undercover “patient” took another “patient” to see Gonzalez, claiming that the new patient had been in an automobile accident.  The new 2007 “patient” was also an OCDA undercover investigator.

 

Between Jan. 26, 2007, and May 2, 2007, the new “patient” made 13 visits to Catinas.  Catinas is accused of billing $3,606 claiming 22 visits.  On March 1, 2007, Gonzalez is accused of paying $300 in cash to the 2005 OCDA undercover investigator “patient” for referring the 2007 “patient.”   On June 19, 2007, Gonzalez sent a letter demanding $15,000 from Infinity Insurance Companies for the new “patient’s” car accident claim, despite knowing that the claim was overstated and fraudulent. 

 

Sometime after Dec. 19, 2007, Gonzalez is accused of illegally splitting the $7,500 check mailed from Infinity Insurance Companies. He is accused of paying $2,000 to Catinas, $1,450 to the 2007 OCDA undercover investigator “patient,” and keeping $2,200 for himself. 

 

Keith Tran Callaway, Chiropractor (walk-in case)

 

Case # 09CF0231

Age: 41

Residence: Huntington Beach

Business Name: Newport Spinal Rehabilitation

Business Address: 16171 Brookhurst Street, Fountain Valley

Felony Charges: one count of conspiracy to commit a crime, one count of insurance fraud, one count of grand theft

Maximum Exposure: 5 years 8 months

Bail: $50,000 - posted

Arrest Date: Feb. 2, 2009

Arraignment Date: March 2, 2009

Department: Central Justice Center, Santa Ana

Ky Hoang Tran, chiropractic administrator (walk-in case)

 

Case # 09CF0231

Age: 67

Residence: Fullerton

Business Name: Newport Spinal Rehabilitation

Business Address: 16171 Brookhurst Street, Fountain Valley

Felony Charges: one count of conspiracy to commit a crime, one count of grand theft

Maximum Exposure: 5 years 8 months

Bail: $50,000 - posted

Arrest Date: Feb. 2, 2009

Arraignment Date: March 3, 2009

Department: Central Justice Center, Santa Ana

Lisa Marie Tran, law office administrator (walk-in case)

 

Case # 09CF0231

Age: 48

Residence: Midway City

Business Name: L&M Legal Services/
Law Offices of Walter Martinez

Business Address: 14482 Beach Boulevard, Westminster

Felony Charges: one count of conspiracy to commit a crime

Misdemeanor Charges: one count of the unauthorized practice of law

Maximum Exposure: 4 years 8 months

Bail: $50,000 - posted

Arrest Date: Feb. 2, 2009

Arraignment Date: March 2, 2009

Department: Central Justice Center, Santa Ana

 

On March 27, 2007, two OCDA undercover investigators posing as “patients” involved in a car accident went to L&M Legal Services/Law Offices of Walter Martinez. Lisa Tran and another office administrator are accused of referring the two undercover investigators to Callaway for “treatment.”  The other office administrator is accused of being told by one of the OCDA undercover investigators that the information on the accident report contained false information. She is accused of coaching the two undercover investigators not to talk to any insurance company officials about the “accident.”  

 

Between March 28, 2007, and July 3, 2007, Ky Tran is accused of “treating” the two OCDA undercover investigators for nine and 11 visits, respectively, at Callaway’s chiropractic office.  She is accused of getting the two OCDA undercover investigators to sign for additional dates where they did not receive “treatment” to falsify the number of visits for billing purposes. 

 

On Nov. 13, 2007, Callaway and Ky Tran are accused of overbilling claiming 25 and 29 visits, amounting to $4,168 and $3,748, knowing most of the billings were fraudulent. On Sept. 7, 2007, a letter from the Law office of Walter Martinez was sent to Infinity Insurance Companies demanding $18,000 and $17,000 for the two OCDA undercover investigators.

 

Sometime after Jan. 29, 2008, Lisa Tran and the other office administrator are accused of splitting two checks for $6,500 and $6,000 with Ky Tran and Callaway, and kicking back $3,250 and $3,000 to the OCDA undercover investigators posing as patients.

 

DEFENDANTS CHARGED WITH ILLEGAL KICKBACK SCHEME

           

Michael Benjamin Saloman, Chiropractor (storefront case)

 

Case # 09CF0149

Age: 42

Residence: Paramount

Business Name: Advanced Chiropractic Medical

Business Address: 1125 E. 17th Street, Santa Ana

Felony Charges: two counts of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 3 years 8 months

Bail: $10,000 - posted

Arrest Date: Feb. 2, 2009

Arraignment Date: March 2, 2009

Department: Central Justice Center, Santa Ana

Layn Ford Miller, Chiropractor (storefront case)

 

Case # 09CF0136

Age: 44

Residence: Westminster

Business Name: The Head, Neck, and Back Pain Relief Center

Business Address: 18279 Brookhurst, Ste. #1, Fountain Valley

Felony Charges: two counts of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 3 years 8 months

Bail: $10,000 - posted

Arrest Date: Feb. 3, 2009

Arraignment Date: March 3, 2009

Department: Central Justice Center, Santa Ana

 

Dung Tuan Le, Chiropractor and Rosalyn Mai, office administrator (storefront case)

Case # 09CF0234

Residence: Westminster

Le’s Age: 56

Mai’s Age: 50

Relationship: Married

Business Name: Dr. Le’s Chiropractic Clinic

Business Address: 9746 Westminster Boulevard, Ste. D3, Garden Grove

Felony Charges: one count each of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 3 years each

Bail: $50,000 – both posted

Arrest Date: Feb. 3, 2009

Arraignment Date: March 4, 2009 - both

Department: Central Justice Center, Santa Ana

Quan Hoang Tran, Chiropractor (storefront case)

 

Case # 09CF0233

Age: 35

Residence: Huntington Beach

Business Name: California Pain Center

Business Address: 9475 Heil Avenue, Ste. D, Fountain Valley

Felony Charges: one count of unlawfully offering or receiving consideration by a claims handler for referral

Maximum Exposure: 3 years

Bail: $50,000 - warrant

Arrest Date: warrant

Arraignment Date: to be determined

Department: to be determined

All of these are separate cases. Each chiropractor or his representative is accused of going to an undercover OCDA law office storefront with the intent to participate in an illegal patient referral scheme after receiving a letter sent by the OCDA, as described above.  These meetings lasted approximately 30 minutes. Each defendant is accused of agreeing to pay 30 percent of his/her insurance company billings to the fake attorney’s office for every patient that the OCDA undercover investigator referred to specifically to him/her.

 

Saloman is accused of making this agreement on March 5, 2008. Miller is accused of making this agreement on July 25, 2007. Mai is accused of going to the storefront on Nov. 16, 2007, and making the agreement, representing to the OCDA undercover investigator that she spoke on behalf of her husband and his chiropractic clinic. Tran is accused of going to the storefront on Nov. 26, 2007, to make this agreement.

 

Between Aug. 28, 2008, and Sept. 11, 2008, an undercover OCDA investigator went to Saloman for three “treatments” under the pretense of having been involved in a car accident. On Jan. 7, 2009, Saloman is accused of accepting $687 from the insurance company for “treatment” rendered and illegally kicking back $295 to the OCDA undercover investigator.

 

Between Aug. 29, 2007, and Nov. 27, 2007, an undercover OCDA investigator went to Miller for 12 “treatments” under the pretense of having been involved in a car accident.  On Jan. 22, 2008, Miller is accused of accepting $1,617 from the insurance company for “treatment” rendered and illegally kicking back $693 to the OCDA undercover investigator.

 

Between Dec. 12, 2007, and March 19, 2008, an undercover OCDA investigator went to Le for 12 “treatments” under the pretense of having been involved in a car accident.  On Aug. 5, 2008, Le and Mai are accused of accepting $1,300 from the insurance company for “treatment” rendered and illegally kicking back $560 to the OCDA undercover investigator.

 

Between Dec. 11, 2007, and March 19, 2008, an undercover OCDA investigator went to Tran for 16 “treatments” under the pretense of having been involved in a car accident.  On Sep. 30, 2008, Tran is accused of accepting $2,200 from the insurance company for “treatment” rendered and illegally kicking back $960 to the OCDA undercover investigator.

 

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