Insurance Fraud NEWS
Chiro runs medical mills in California, bills $5.6M
July 18, 2018, Los Angeles, CA
A chiropractor accused of running medical mills in Los Angeles and California's Central Valley pleaded guilty to a single count of aiding and abetting health care fraud, and a psychologist charged with paying kickbacks for referrals pleaded guilty to fraud.
Bahar Gharib-Danesh, a chiropractor in Woodland Hills, pleaded guilty July 5 to aiding the fraudulent activities of another chiropractor.
Danesh signed a plea agreement saying she directed staff to forward to a third-party billing agency invoices submitted by a person identified as "N.E." Danesh forwarded the invoices for payment despite being "aware of a high probability that claims submitted by her for N.E. were false and she deliberately avoided learning and/or reckless disregarded the truth that the bills fraudulently claimed payment for medical-legal reports using codes ML 102 and ML 103."
The plea agreement also says carriers never paid the fraudulent bills Danesh submitted on behalf of "N.E," so she is not required to pay restitution.
The person identified as "N.E." in Danesh's indictment appears to be chiropractor Na Young Eoh, who in May pleaded guilty to charges of writing unauthorized medical-legal reports and billing carriers a total of $5,686.79.
Eoh worked at Pain Relief Health Center clinics that Danesh operated in Bakersfield, Visalia and Fresno According to the 2015 indictment, Eoh was the "primary source of billings and referral" for the three clinics.
John Terrence, a school psychologist from Marina Del Rey, leased space in Danesh's clinic and used Pain Relief Health Center to handle billing. Terrence pleaded guilty to one count of health care fraud Monday.
Terrence admitted that he used Skpe to see patients and then generated reports that were "virtually word-for-word identical." Bills submitted to carriers "were identical for each patient," the plea agreement says.
Terrence also improperly billed for medical-legal reports. The plea agreement doesn't elaborate, but the indictment accused Terrence of holding himself out as a qualified medical evaluator when he wasn't certified to act as a QME.
Terrence's plea agreement states that restitution will be determined by the court in an amount not to exceed $2.5 million.
Finally, Pain Free Management Co. pleaded guilty to one count of conspiracy to commit health care fraud. Pain Free Management Co. was the operating name for Pain Free Diagnostic, Inc., another company operated by Danesh.
Pain Free Management Co. had an agreement to bill for services provided by Terrence. In all, the company submitted bills for services by Terrence demanding payment of $2.5 million.
The plea agreement states Pain Free Diagnostic will pay $1.2 million in restitution.
All defendants face a maximum fine of $250,000 and a sentence of 10 years in prison. Eoh is scheduled to be sentenced Sept. 4. Danesh is scheduled to be sentence Oct. 1. Terrence is scheduled to be sentenced Oct. 22.