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Fairbanks Insurance Blog

News & Updates
04 May 2018

WC News: Giant California Workers Compensation Fraud Ring Exposed

According to Business Insurance.Com, a large group of California doctors, pharmacists and business owners will be facing insurance fraud charges resulting from a $40 million fraudulent workers comp medical billing and kickback scheme that was uncovered by federal, state and local insurance regulators. The nefarious scheme that siphons off millions of dollars from insurers was uncovered in April of last year according to the Orange County, California District Attorney’s office.

“Defendants Tanya Moreland King, 37, and her husband Christopher King, 38, both of Beverly Hills, California, own medical billing and medical management companies Monarch Medical Group Inc., King Medical Management Inc. and One Source Laboratories Inc.

Both are accused of masterminding a complex insurance fraud scheme of recruiting doctors and pharmacists to prescribe unnecessary treatment for workers comp patients between 2011 and 2015, according to the news release.

Also named in the release are Irvine, California pharmacists Charles Bonner, 56, and Mervyn Miller, 66, owners of Steven’s Pharmacy in Costa Mesa, California. Both allegedly conspired with Mr. and Ms. King by selling more than $1 million in compound creams that were not approved by the U.S. Food and Drug Administration, nor have known medical benefits, according to the district attorney’s office.”

According to the California DA, more than 13,000 patients and approximately 27 insurers were victimized in the scheme, and that over $23 million in claims were paid out to the defendants and a total of $40 million was billed to various insurers.

Among the allegations brought against the defendants, Mr. and Ms. King purchased the creams at $15 to $40 per tube and then turned around and billed their patients’ workers comp insurers at $250 to $700 per tube. Additionally, Ms. King is accused of recruiting the physicians who would participate in the scam by paying them for their efforts. The Kings also allegedly purchased and then repackaged oral pain meds and the sent bills directly to the physicians that were recruited for the scam.

The Kings were also accused of providing unneeded urine tests which were ordered by the physicians who conspired in the scam under the pretense of verifying that the patients were taking their meds that were prescribed.

Those who are scammed the most by these types of activities are the innocent contractors and other business that pay higher workers compensation rates because of premium dollars stolen by these types of criminals.

Read the Full Article Here