15 Charged in One of Largest Insurance Fraud Scams in Calif. History
On Tuesday, California prosecutors alleged that a doctor and more than a dozen associates fraudulently billed insurers for about $150 million in what the Los Angeles District Attorney's Office called "one of the largest insurance fraud scams in state history," AP/KPCC's "KPCC News" reports (Melley, "KPCC News," AP/KPCC, 9/15).
In two indictments unsealed Tuesday, prosecutors said a five-year investigation found a scam in which attorneys and other individuals referred patients to certain medical clinics run by a physician named Munir Uwaydah in exchange for as much as $10,000 per month.
According to the indictments, a doctor at the clinic documented evaluations that never happened, while staff falsified records to justify surgeries, some of which were unnecessary. Further, the indictment said some surgeries were performed by a physician's assistant who had not attended medical school and was not overseen by a surgeon during the procedures.
As a result, nearly two dozen patients received lasting scars and many sought additional surgeries to repair damage, according to the District Attorney's Office.
Details of Charges
The two indictments list 132 felonies and name Uwaydah and 14 others as defendants, including his PA and billing manager.
According to the District Attorney's Office, Uwaydah was arrested in Germany and is awaiting extradition to the U.S. Meanwhile, 11 defendants on Tuesday appeared in court and pleaded not guilty to the charges.
Uwaydah and 10 other defendants have been charged with conspiracy, insurance fraud, aggravated mayhem and capping, which includes wrongful patient referrals.
Meanwhile, David Johnson, a physician working for Uwaydah, has been charged with overbilling insurance companies for prescription drugs and medical exams he did not actually conduct.
Uwaydah's office manager and another defendant have been charged with falsifying documents related to a case that the California Medical Board brought against Uwaydah in 2009, which eventually resulted in the cancellation of his license in 2013.
In a separate indictment, Uwaydah's attorney and three others have been charged with conspiracy to commit insurance fraud, money laundering, illegal patient referrals and filing false tax returns.
Uwaydah and 11 others face up to life in state prison if convicted, according to the district attorney's office.
In a statement, District Attorney Jackie Lacey said, "Although the patient victims sustained physical harm, we who pay higher premiums for health care suffer economic harm when scams are allowed to continue unchecked" (Winton/Hamilton, "L.A. Now," Los Angeles Times, 9/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.