Health care fraud is unfortunately prevalent in New York and around the country. In one of the latest cases to receive publicity, a California surgeon has been indicted on charges related to an alleged fraud scheme. The report stated that the surgeon and 14 associates were accused of obtaining approximately $150 million illegally from insurance companies.
In this case, 21 patients were reportedly told that they would receive surgery from the doctor. However, once they were under anesthesia, his physician's assistant who had not gone to medical school reportedly did the actual operation. As a result, all of the patients reportedly suffered substantial injuries that often required further medical treatment in addition to psychological trauma.
The 49-year-old doctor was taken into custody in Germany where he remained until he could be extradited. There were two indictments that were unsealed. One was a 57-count indictment from February while the other was a 75-count indictment from August. The charges range from numerous counts of insurance fraud, aggravated mayhem, conspiracy to commit insurance fraud and money laundering, among other alleged crimes. Those who were named in the first indictment reportedly face a maximum sentence of life in prison.
A person who is accused of medical billing fraud or other white-collar crimes faces serious consequences if convicted, including incarceration, fines and the loss of a professional license. Potential defense strategies that may be available to the defendant's attorney might include demonstrating that the client played a minor role in the operation, which could possibly lead to an agreement with the prosecutor that would reduce the penalties in exchange for testimony against others.
Source: CBS News, "Surgeon alleged ringleader in $150 million insurance scam", 09/16/2015