FRESNO: Clinic, Doctor Accused of Insurance Fraud
Allstate Insurance Company has filed a civil lawsuit against Fresno-based Sunnyside Medical Clinic and owners Dr. Jose Ibarra and his wife, Ivette, alleging that the clinic filed fraudulent insurance claims, the Fresno Bee reports. Seeking $3 million in damages, Allstate claims that the Ibarras "knowingly made ... fraudulent claims for payment of health care benefits" and deposited some of the payments into mutual funds and savings accounts while using the rest to buy real estate and personal property. The case was investigated by Allstate's regional Special Investigation Unit, which believes that the Ibarras' office was "upcoding" -- misusing billing codes to "show a much more involved procedure." Diane Sheldon, the investigation unit manager said that Ibarra was giving "unqualified care on the basis of profit and did not take in consideration patients' safety or well-being." Rather than performing therapy, Sheldon contends that Ibarra referred patients to other clinics for further treatment that was often "not medically necessary." The case is based on the billing records of 125 patients over a three year period, who were involved in "fender-bender" type accidents. Calling the allegations "ridiculous," Ibarra said he and his wife had to retrieve the complaint from the Fresno courthouse because Allstate went to the media before serving the papers. Ibarra -- who claims that only 5% of his patients are personal injury accident cases -- accused the insurer of "picking on a small practice that primarily treats poor patients in southeast Fresno" (Correa, 10/21).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.