Insurance Fraud NEWS
Chicago chiro bills insurers for phantom treatment
December 04, 2018, Chicago, IL
A federal jury has convicted a Chicago doctor on fraud charges for billing insurance companies for purported chiropractic manipulations that were never performed, the U.S. Attorney’s Office for the Northern District of Illinois reported.
Dr. Paul Madison, an anesthesiologist and pain management specialist, owned Watertower SurgiCenter LLC, an outpatient surgical center on North Michigan Avenue in Chicago.
The U.S. Attorney’s Office reported that from 2005 to 2009, under Dr. Madison’s direction, Watertower’s billing staff submitted false bills to insurers for manipulation-under-anesthesia of body parts that chiropractors at Watertower had not actually performed.
Dr. Madison and others falsified patient records to support the fraudulent health insurance claim forms and submitted the claims to patients’ insurance companies for payment. Evidence at trial revealed that Dr. Madison disguised Watertower’s fraudulent billing by creating false medical and billing records. In at least two instances, Dr. Madison included in the fraudulent billings the names, addresses and dates of birth of patients without their knowledge.
The jury in federal court in Chicago convicted Dr. Madison, 65, of Chicago, on all 11 counts against him. The conviction includes six counts of health care fraud, three counts of making false statements in connection with the delivery of health care services, and two counts of aggravated identity theft. U.S. District Judge Robert M. Dow, Jr., set sentencing for March 25, 2019.
Each count of health care fraud is punishable by a maximum sentence of 10 years in prison, while the false statement counts each carry a maximum penalty of five years. Each aggravated identity theft count carries a mandatory consecutive sentence of two years. The Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The verdict was announced by John R. Lausch, Jr., United States Attorney for the Northern District of Illinois; Jeffrey S. Sallet, Special Agent-in-Charge of the Chicago office of the Federal Bureau of Investigation; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor’s Office of Inspector General in Chicago. The government is represented by Assistant U.S. Attorneys Edward G. Kohler and Jennie Levin.
Source: Insurance Journal