Workers' Comp Fraud Blotter (1/3/2013) – Anesthesiologist Who Submitted False Medical Bills May Lose His Rolls Royce

Workers' Comp Fraud Blotter (1/3/2013) – Anesthesiologist Who Submitted False Medical Bills May Lose His Rolls Royce

Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, convictions and investigations.

 

Workers' Comp Fraud Blotter - January 3, 2013 

Anesthesiologist Who Submitted False Medical Bills May Lose His Rolls Royce Corniche Convertible (IL) - Dr. Paul Madison, an anesthesiologist and pain management specialist who owned the Watertower SurgiCenter LLC, has been indicted on federal charges for allegedly causing $3.5 million in false medical bills to be submitted to 10 private health insurance companies and the federal workers' compensation program. A nurse at the facility, Jeanette Shin, has also been charged with making false statements in medical reports. According to the indictment, between August 2005 and December 2009, Madison directed Watertower's billing staff to submit false bills to insurers for manipulation-under-anesthesia (MUA) that chiropractors had not performed. An MUA involves a chiropractor performing adjustments on a patient who had been anesthetized. Madison disguised Watertower's fraudulent billing by creating false medical and billing records, and by directing Watertower's billing staff, nurses, chiropractors, and others to create false records, including false nurses' reports, chiropractors' reports, operative reports, and billing reports, the charges allege, and these false records disguised the true nature of the MUA procedures that chiropractors had performed on patients at Watertower. Shin allegedly falsified her nurse's reports by fraudulently claiming that chiropractors had performed certain MUAs that she knew they had not actually performed. In the indictment, the government seeks the forfeiture of Madison's 1978 Rolls Royce Corniche and his 2004 Porsche Cayenne, as well as Shin's home.   Read more

Letter Carrier Who Operated Adult Online Sex Business While Disabled Challenges Jury Verdict (IN) - Former postal employee Chopper Loughran has filed a motion for acquittal on charges of making false statements in connection with federal workers' compensation benefits as a result of her conviction by a federal court jury. Loughran, who operated an eBay business, Chopper's Playhouse, where she sold adult sex toys while she was receiving disability benefits, claims that the evidence was insufficient to prove that she submitted false mileage and child care reimbursement requests.   Read more

President of Trucking Firm Indicted For Failing To Carry Workers' Compensation Insurance (IL) - John Linek, individually, and as President of SMS Logistics, is facing a felony charge of failing to carry workers' compensation insurance. Linek had workers' comp insurance on several other businesses but operated his trucking business without such insurance, even after an employee was injured.   Read more

Police Officer Loses Appeal and Ordered To pay Costs For Filing Fraudulent Workers' Comp Claims (LA) - The Louisiana Court of Appeal has affirmed the decision of the Office of Workers Compensation (OWC) assessing and fixing the amounts due for various costs against Marshall Price, who had filed disputed claims for compensation alleging three separate work-related incidents that occurred while he was employed as a police officer with the City of Ponchatoula for which he allegedly sustained injuries. The OWC had ruled against Price's claims because of fraud and assessed the costs against him.   Read more

Ex-Cop Charged With Lying About Injury At Work In Order To Get $188,000 In Benefits (IL) - Richard A. Turner, a former police officer for the Village of Maryville, has been charged with filing a false workers' compensation claim that resulted in him receiving $38,000 in compensation from the village and more than $150,000 from the Illinois Municipal League Risk Management Association. Turner claimed that he injured his back while working, but the indictment alleges that he was not working at the time of the injury.   Read more

Damages Against Staff Leasing Agency For Failing to Provide Workers' Comp Insurance Reduced On Appeal (TX) - The Texas Court of Appeals has reduced a verdict that had awarded about $9,000,000 against a staff leasing agency, Business Staffing, Inc., after an employee from the agency, Hector Viesca, was killed while working for an oil field operator, Wiley Lease Co., and it was subsequently discovered that the employee and the oil field operator were not covered by the leasing agency's workers' compensation insurance as had been agreed to in the contract between the agency and the operator. The total amount of damages against the agency was reduced to under $5,000,000 on appeal.   Read more

Owner of Transportation Company Breached Agreement To Obtain Workers' Compensation Insurance (IL) - Kevin Warren, individually, and as President and Secretary of Symphony Transport a/k/a Big R Transport, has been indicted for felony failure to maintain workers' compensation insurance. Warren agreed to secure insurance and signed a settlement agreement to pay a $10,000 fine. He never complied with the agreement, and the insurance he secured was cancelled within a few months.   Read more

Surveillance Video Of Substandard Care By Doctor Leads To Ban On Treating Injured Workers (OH) - Anil C. Nalluri, MD, has been decertified as a provider for the Ohio Bureau of Workers' Compensation,  and Nallurir has paid more than $70,000 after pleading guilty to workers' compensation fraud. Surveillance video captured by an undercover agent posing as a patient in need of psychotherapy services showed Nalluri providing inadequate care, and Nalluri later billed the bureau for services he never provided. The undercover agent visited Nalluri 12 times and captured video supporting the allegation, including an appointment that lasted one minute. In another instance, the bureau was billed for a 20 to 30 minute psychotherapy session that video showed lasted three and one-half minutes and consisted primarily of discussions about the economy.   Read more

Failure To Pay for Workers' Compensation Insurance Leads To Felony Indictment (IL) - Ahmed Ghosien, d/b/a Ghosien European Auto Werks, has been charged with failing to carry workers' compensation insurance. Ghosien agreed to secure the insurance and pay a fine for noncompliance, but he never made payments and the insurance was cancelled a few months later for nonpayment.   Read more

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