The United States Attorney’s Office for the Middle District of Pennsylvania announced that a Waynesboro, Pennsylvania chiropractor has pleaded guilty to charges stemming from a bogus automobile accident personal injury claim.
According to United States Attorney Peter J. Smith, Lawrence S. Herman, age 47, a resident of Frederick, Maryland, and the owner/operator of Herman Chiropractic in Waynesboro, Pennsylvania, pleaded guilty to a one count Information charging him with false statements in health care matters. Herman entered his guilty plea today in United States District Court in Harrisburg before the Honorable Sylvia Rambo in Harrisburg. The plea was entered by Herman pursuant to a plea agreement with the government.
The charges stem from a claim Herman submitted to the USAA insurance company in May 2012 for injuries allegedly suffered in an August 16, 2011 automobile accident in Maryland. In May 2012, Herman supported his claim with records indicating he was treated by a chiropractor for neck and back injuries between August 2011 and January 2012. When USAA did not immediately honor the claim, Herman hired a Baltimore area law firm to demand $60,000 from USAA for reimbursement of his chiropractic treatment expenses and for pain and suffering.
During the guilty plea hearing, Herman admitted the chiropractic treatment records were false and were created, at his direction, by a chiropractor who worked for him in his Waynesboro office. To conceal the fact the chiropractor was his employee, the fraudulent treatment records were submitted to USAA under a fictitious business letterhead created by Herman.
Assistant U.S. Attorney Kim Douglas Daniel stated during the hearing that Herman was not injured in the accident and in fact participated in several 5K, 10K, half-marathon, and marathon foot races during the period when Herman was supposedly being treated for his injuries in late 2011.
The case was investigated by the Harrisburg Office of the FBI and is being prosecuted by Assistant United States Attorney Kim Douglas Daniel.
A sentence following a finding of guilty is imposed by the Judge after consideration of the applicable federal sentencing statutes and the Federal Sentencing Guidelines.
In this case, the maximum penalty under the federal statute is five years’ imprisonment, a term of supervised release following imprisonment, and a fine. Under the Federal Sentencing Guidelines, the judge is also required to consider and weigh a number of factors, including the nature, circumstances and seriousness of the offense; the history and characteristics of the defendant; and the need to punish the defendant, protect, the public and provide for the defendant’s educational, vocational, and medical needs. For these reasons, the statutory maximum penalty for the offense is not an accurate indicator of the potential sentence for a specific defendant.
Showing posts with label chiropractic. Show all posts
Showing posts with label chiropractic. Show all posts
Thursday, December 12, 2013
Tuesday, September 10, 2013
Former Bryan Chiropractic Clinic Owner Convicted in $3 Million Auto Insurance Fraud Conspiracy
HOUSTON—The former owner of Private Chiropractic Care in Bryan has entered a plea of guilty to engaging in a conspiracy to defraud various automobile insurance companies of more than $3 million, announced United States Attorney Kenneth Magidson.
Brittany Jessie, 24, admitted she participated in a three-year conspiracy to defraud numerous auto insurance companies by creating fraudulent chiropractic bills for chiropractic treatments which were never performed and used as support for fraudulent settlement demand letters sent to auto insurance companies.
During her plea, Jessie admitted that she, Marion Young, 52, and Chase Lindsey, 35, and others engaged in a conspiracy to defraud auto insurance companies. Jessie worked both at Sanjoh and Associates Law Firm in Bryan and as a tech at the chiropractic clinics run by Young, Lindsey, and others. Lindsey is a chiropractor licensed to practice in the state of Texas.
Jessie sometimes cashed checks and took the cash to Lindsey for payment. Lindsey routinely prescribed medically unnecessary treatment which was provided, if at all, by unlicensed, untrained, and unqualified individuals, including Jessie. Lindsey always prescribed the same six treatments, but the patients usually received only two: ice/heat packs and electric stimulation. Lindsey prescribed the treatments be done three to work times per week for five to six weeks, but the patients usually went once a week for three to four weeks, and many did not even go back for treatment after one or two visits.
Jessie was instructed on which treatments to mark down in order for the billing to be approved and to alternate treatments on the billing so it did not look suspicious. At one point, Jessie provided a set of treatment guidelines to an employee at Private Chiropractic Care to follow which were needed for the billing of patients. Jessie instructed that employee to mark down patient treatments, even if the treatments were not done, because it was necessary for billing. Jessie further instructed the employee to have the patients initial off next to the fraudulent treatments as if they received them.
Jessie also fraudulently marked down treatments and the patient’s pain levels on treatment forms at the Sanjoh & Associates office when the patient had not received the treatment. She also prepared the false chiropractic billing statements at Sanjoh & Associates. Although most of the treatments billed were never performed, Jessie created false and fraudulent chiropractic bills under Lindsey’s name for each of the four clinics in the scheme—Texas Avenue Chiropractic Clinic, H & E Chiropractic, Private Chiropractic Care, and Lindsey Chiropractic Care.
Despite changing the name and location of the chiropractic clinic four times, the fraud scheme remained the same. Jessie knew the fraudulent bills she created were used as support for settlement demand letters sent to auto insurance companies. The fraudulent demand letters caused the insurance companies to issue settlement checks and place those checks into the U.S. mail to be delivered to Sanjoh & Associates.
Jessie acknowledged the scheme to defraud the automobile insurance companies resulted in the submission of more than $3 million in false billing claims. The insurance companies paid at least $940,000 in false claims during 2007-2009, during which time Jessie was paid at least $22,637.
U.S. District Judge Kenneth Hoyt, who accepted the guilty plea, has set sentencing for December 2, 2013, at which time she faces a maximum penalty of 20 years’ imprisonment and a possible $250,000 fine. As part of her plea agreement, Jessie has also agreed to pay restitution of approximately $941,000 to the insurance companies victimized by the scheme. She was permitted to remain on bond pending her sentencing.
Lindsey and Young both previously pleaded guilty and are scheduled to be sentenced in early 2014. The remaining two defendants charged in the case are scheduled for trial on September 24, 2013. They are presumed innocent unless and until convicted through due process of law.
The criminal charges are the result of a joint investigation by agents of the FBI and the National Insurance Crime Bureau. This case is being prosecuted by Assistant United States Attorney Al Balboni and Special Assistant United States Attorney Adrienne Frazior.
Brittany Jessie, 24, admitted she participated in a three-year conspiracy to defraud numerous auto insurance companies by creating fraudulent chiropractic bills for chiropractic treatments which were never performed and used as support for fraudulent settlement demand letters sent to auto insurance companies.
During her plea, Jessie admitted that she, Marion Young, 52, and Chase Lindsey, 35, and others engaged in a conspiracy to defraud auto insurance companies. Jessie worked both at Sanjoh and Associates Law Firm in Bryan and as a tech at the chiropractic clinics run by Young, Lindsey, and others. Lindsey is a chiropractor licensed to practice in the state of Texas.
Jessie sometimes cashed checks and took the cash to Lindsey for payment. Lindsey routinely prescribed medically unnecessary treatment which was provided, if at all, by unlicensed, untrained, and unqualified individuals, including Jessie. Lindsey always prescribed the same six treatments, but the patients usually received only two: ice/heat packs and electric stimulation. Lindsey prescribed the treatments be done three to work times per week for five to six weeks, but the patients usually went once a week for three to four weeks, and many did not even go back for treatment after one or two visits.
Jessie was instructed on which treatments to mark down in order for the billing to be approved and to alternate treatments on the billing so it did not look suspicious. At one point, Jessie provided a set of treatment guidelines to an employee at Private Chiropractic Care to follow which were needed for the billing of patients. Jessie instructed that employee to mark down patient treatments, even if the treatments were not done, because it was necessary for billing. Jessie further instructed the employee to have the patients initial off next to the fraudulent treatments as if they received them.
Jessie also fraudulently marked down treatments and the patient’s pain levels on treatment forms at the Sanjoh & Associates office when the patient had not received the treatment. She also prepared the false chiropractic billing statements at Sanjoh & Associates. Although most of the treatments billed were never performed, Jessie created false and fraudulent chiropractic bills under Lindsey’s name for each of the four clinics in the scheme—Texas Avenue Chiropractic Clinic, H & E Chiropractic, Private Chiropractic Care, and Lindsey Chiropractic Care.
Despite changing the name and location of the chiropractic clinic four times, the fraud scheme remained the same. Jessie knew the fraudulent bills she created were used as support for settlement demand letters sent to auto insurance companies. The fraudulent demand letters caused the insurance companies to issue settlement checks and place those checks into the U.S. mail to be delivered to Sanjoh & Associates.
Jessie acknowledged the scheme to defraud the automobile insurance companies resulted in the submission of more than $3 million in false billing claims. The insurance companies paid at least $940,000 in false claims during 2007-2009, during which time Jessie was paid at least $22,637.
U.S. District Judge Kenneth Hoyt, who accepted the guilty plea, has set sentencing for December 2, 2013, at which time she faces a maximum penalty of 20 years’ imprisonment and a possible $250,000 fine. As part of her plea agreement, Jessie has also agreed to pay restitution of approximately $941,000 to the insurance companies victimized by the scheme. She was permitted to remain on bond pending her sentencing.
Lindsey and Young both previously pleaded guilty and are scheduled to be sentenced in early 2014. The remaining two defendants charged in the case are scheduled for trial on September 24, 2013. They are presumed innocent unless and until convicted through due process of law.
The criminal charges are the result of a joint investigation by agents of the FBI and the National Insurance Crime Bureau. This case is being prosecuted by Assistant United States Attorney Al Balboni and Special Assistant United States Attorney Adrienne Frazior.
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