Posted By CotoBlogzz
Rancho
Santa Margarita, CA - Mario Rosenberg & Roy Dickson, a doctor
and an attorney, have been convicted for their role in the largest medical
fraud prosecution in the nation for recruiting thousands of healthy patients to
undergo unnecessary and dangerous surgeries to fraudulently bill medical
insurance companies, according to the Orange County District Attorney’s (OCDA)
office.
Attorney
Roy Chester Dickson, 65, Yorba Linda, pleaded guilty today, Jan. 30, 2014, to
one felony count of money laundering and one felony count of grand theft with
white collar crime sentencing enhancements. In the same case, Dickson was found
guilty by a jury Nov. 26, 2012, of two felony counts of filing a false personal
tax return and was sentenced Dec. 20, 2012, to two years and eight months in
state prison and $41,629 restitution on the tax conviction. He is scheduled to
be sentenced for today's convictions Aug. 8,
2014.
Doctor
Mario Rosenberg, 66, pleaded np cpntest Jan. 24, 2014, to two felony counts of
insurance fraud and white collar crime sentencing enhancements.
The duo participated in the Unity case, a $154 million medical insurance fraud scheme that recruited 2,841
healthy people from all over the country to receive unnecessary surgeries in
exchange for money or low cost cosmetic surgery. Insurance companies paid out
more than $20 million over a 9-month period.
The
Orange County Grand Jury examined 1,054 exhibits and heard testimony from 56
witnesses over 28 days, resulting in a 70-page indictment. The indicted
defendants include an attorney, accountant, three doctors, and patient
recruiters known as "cappers."
Unity
was jointly investigated by the California Department of Insurance and Orange
County District Attorney's Office with assistance from the California Franchise
Tax Board.
Co-Defendants
Andrew
Robert Harnen, 59, Rosemead, Unity's accountant, pleaded guilty to the court
Aug. 16, 2013, to two felony counts of conspiracy, eight felony counts of
capping or paying for patient referrals, 30 felony counts of grand theft, 30
felony counts of insurance fraud, 30 felony counts of making false and
fraudulent claims, one felony count of filing a false tax return, and white
collar crime sentencing enhancements for taking over $2.5 million. Harnen was
sentenced to five years and four months in prison. The OCDA advocated for a
sentence of 41 years and eight months in state prison. The sentence will be
served concurrent to the sentence he received Dec. 20, 2012. The defendant was
previously sentenced to prison and ordered $904,780 restitution for his Nov.
26, 2012, conviction by a jury of three felony counts of filing a false tax
return and six counts of failing to file tax returns.
Doctor
William Wilson Hampton, Jr., 58, Seal Beach, pleaded guilty May 8, 2009, to 47
felony counts including conspiracy, insurance fraud, and capping and was
sentenced to 16 years in state prison.
Doctor
Michael Cheeluen Chan, 68, Cerritos, pleaded guilty Aug. 4, 2011, to the court
to 40 felony counts including conspiracy to commit insurance fraud, insurance
fraud, aiding and abetting capping with white collar crime sentencing
enhancements. He faces a sentence ranging from probation up to 28 years in
state prison at his sentencing March 28,
2014.
Capper
Sue Nanda, 45, Costa Mesa, pleaded guilty Feb. 20, 2009, to 22 felony counts
including conspiracy, capping, grand theft, filing false tax returns, failing
to file tax returns, and making false and fraudulent statements. Nanda was
sentenced to 10 years in state prison and ordered to pay over $500,000 in
restitution for personal and corporate back taxes.
Capper
Maria DeJesus Licea Rosales, 46, pleaded guilty Aug. 7, 2009, to 96 felony
counts including conspiracy, capping, insurance fraud, grand theft, filing
fraudulent tax returns, and sentencing enhancements for white collar crime and
loss over $2.5 million. She was sentenced to eight years in state prison.
Capper
Olga Lilia Toscano, 46, pleaded guilty Aug. 11, 2009, to the court to 98 felony
counts including conspiracy, capping, insurance fraud, grand theft, tax
evasion, and sentencing enhancements for aggravated white collar crime and loss
exceeding $2.5 million. She was sentenced to eight years in state prison.
Capper
Ngoc Trang Huynh, 54, pleaded guilty Aug. 19, 2011, to 56 felony counts
including conspiracy, capping, insurance fraud, grand theft, tax evasion,
filing a false income tax return, and sentencing enhancements for aggravated
white collar crime and loss exceeding $2.5 million. He faces a maximum of 45
years and eight months in state prison at his sentencing March 28, 2014.
Capper
Pancha Keophimphone, 62, pleaded guilty to a court offer Aug. 19, 2011, to 56
felony counts including conspiracy, capping, insurance fraud, grand theft, tax
evasion, and sentencing enhancements for aggravated white collar crime and loss
exceeding $2.5 million. Keophimphone was sentenced to 12 years in state prison
stayed pending completion of five years formal probation. She was ordered to
serve one year in jail.
Capper
Thuy Thu Huynh, 55, pleaded guilty Aug. 25, 2011, to 58 felony counts including
conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing
enhancements for aggravated white collar crime and loss exceeding $2.5 million.
Huynh is scheduled to be sentenced March 28, 2014
Capper
Henry Truong, 46, pleaded guilty April 7, 2006, to 13 felony counts including
conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing
enhancements for aggravated white collar crime and loss exceeding $2.5 million.
Truong was sentenced to 12 years in state prison and ordered to pay
restitution.
Cappers
Amanda Phuc Tran, 54, and Nicholas Vu, 56, pleaded guilty Nov. 21, 2005, to two
felony counts each of insurance fraud and making false or fraudulent claims
with sentencing enhancements for loss exceeding $2.5 million. Tran and Vu were
sentenced to five years in prison stayed pending 10 years formal probation and
ordered to pay restitution.
Administrator
Tam Vu Pham, 49, pleaded guilty Dec. 27, 2005, to one felony count each of
conspiracy and money laundering, eight felony counts of capping or paying for
referrals, three felony counts of making false or fraudulent claims, and two
felony counts of insurance fraud, with sentencing enhancements for aggravated
white collar crime, loss exceeding $2.5 million, and laundering over $150,000,
Pham was sentenced to 12 years in prison and ordered to pay restitution.
Administrator
Huong Thien Ngo, 47, pleaded guilty Dec. 27, 2005, to one felony count each of
conspiracy, making false or fraudulent claims, tax evasion, and money
laundering, with sentencing enhancements for aggravated white collar crime,
loss exceeding $2.5 million, and laundering over $150,000. Ngo was sentenced to
seven years in prison suspended pending six years of formal probation and
ordered to pay restitution.
Administrator
Lan Thi Ngoc Nguyen, 57, pleaded guilty Dec. 27, 2005, to one felony count each
of conspiracy, making false or fraudulent claims, and filing a false tax
return, with sentencing enhancements for aggravated white collar crime and loss
exceeding 42.5 million. Nguyen was sentenced to five years in state prison
suspended pending six years of formal probation and ordered to pay restitution.
Administrator
Dee Francis, 64, pleaded guilty to the court Jan. 11, 2013, to two felony
counts of conspiracy, eight felony counts of capping or paying for referrals,
30 felony counts of grand theft, 30 felony counts of insurance fraud, 30 felony
counts of making false and fraudulent claims, one felony count of filing a
false tax return, and white collar crime sentencing enhancements for taking
over $2.5 million. Francis was sentenced to six years in state prison Jan. 11,
2013. The People advocated for a sentence of 55 years in state prison. The
sentence will be served concurrent to the sentence he received Dec. 20, 2012,
of six years in state prison and $905,507 restitution for a Nov. 26, 2012,
conviction by a jury of one felony count of filing a false tax return and six
felony counts of failing to file tax returns.
Administrator
Rosalinda Rodriguez Landon, 68, pleaded guilty to the court Jan. 11, 2013, to
two felony counts of conspiracy, eight felony counts of capping or paying for
referrals, 30 felony counts of grand theft, 30 felony counts of insurance
fraud, 30 felony counts of making false and fraudulent claims, one felony count
of money laundering, and white collar crime sentencing enhancements for taking
over $2.5 million. Landon was sentenced to five years and four months in state
prison Jan. 11, 2013. The People advocated for a sentence of 55 years in state
prison. The sentence will be served concurrent to the sentence she received
Dec. 20, 2012, of five years and four months in state prison and $1,104,496
restitution for a Nov. 26, 2012, conviction by a jury of six felony counts of
filing false tax returns.
Cappers
Keophimphone,
Ngoc Huynh, Thuy Thu Huynh, Toscano, Nanda, Rosales, Truong, Tran, and Vu, have
pleaded guilty to multiple felony counts of capping.
The
Unity cappers targeted employees from businesses in 39 states who were covered
by PPO insurance plans, affecting more than 1,000 employers whose employees
became involved in this scheme. They arranged transportation for the patients,
scheduled the surgeries, and coached the healthy "patients" on what
to say. In exchange for undergoing surgery, the patients received a cash
payment, usually between $300 and $1,000 per surgery, or credit toward a free
or discounted cosmetic surgery.
Keophimphone
personally recruited 118 patients from 17 different states for 297 surgical
procedures. These so-called patients, who were mostly coming from other states
besides California, resulted in over $8 million in billings to insurance
companies for unnecessary surgical procedures. Ngoc Huynh personally recruited
67 so-called patients, most coming from outside California. These so-called
patients received 151 unnecessary medical procedures resulting in over $4
million in billings to insurance companies.
Rosales
recruited over 90 so-called patients, all of whom were from California. Nanda
recruited over 170 so-called patients from 16 different states for unnecessary
surgical procedures. They had no medical training, yet recruited patients with
PPO insurance, scheduled surgical procedures, and coached patients to correctly
describe symptoms for the unnecessary surgical procedures. They assisted
patients in filling out surgery center paperwork, including having them sign a
false affidavit stating that they had not been offered compensation and had not
received any compensation in exchange for using Unity's services. For Unity
capping, Nanda was paid directly and through corporations she had set up.
The
three doctors charged in this case participated in medical insurance fraud for
performing unnecessary medical procedures on healthy people with the knowledge
that the patients were being recruited. Doctors Chan, Hampton, and Rosenberg
performed a total of 1,037 procedures, resulting in insurance billings exceeding
$30 million for the facilities fees alone. Unity received over $5.1 million in
payment as a result of the surgeries performed by these doctors.
The
doctors performed many of the surgeries on Saturdays and Sundays and often
performed the same procedures on co-workers or members of the same household on
the same day. The doctors ignored basic medical protocols such as: 1) Patients
receiving surgeries on consecutive days instead of under one anesthesia; 2)
Doctors not meeting the patients prior to operating; 3) Doctors not following
up with patients after the procedure was completed; and 4) Doctors not
obtaining necessary medical information.
Chan
worked as the Medical Director at Unity and specialized in invasive
gynecological procedures. He performed unnecessary surgeries on 161 patients
including include laproscopy, tubaligation, colporrhaphy, and hysterectomy
procedures. Not a single one of Chan's patients were referred by a doctor or
were medically necessary. Every patient Chan operated on was referred by a
capper, 88 percent being referred by cappers charged in this case. Of Chan's
patients, 60 percent were flown in for the unnecessary surgeries from 18 states
outside of California.
Hampton,
a general surgeon, performed 180 procedures on 178 patients. He primarily
performed thoracic sympathectomies, also known as sweaty palm surgeries, a
highly unusual and dangerous medical procedure that can often be treated with
topical creams, medication, and botox. Of the patients that underwent surgery
by Hampton, 97 percent were referred by Unity cappers. Hampton was also
indicted and convicted by the federal government for his involvement in a
scheme similar to the Unity case.
Attorney
Dickson went to Unity after having previously managed and represented another
surgery center involved in similar illegal activities. He was sanctioned by the
federal bankruptcy court for filing a fraudulent bankruptcy claim for a doctor
at that surgery center. Dickson was hired by Unity to collect payments from insurance
companies and patients. He helped the surgery scheme by creating fraudulent
documents to disguise illegal capping activities.
Immediately
after the OCDA searched Unity in April 2003, Dickson used his attorney client
trust account to keep Unity open and operating and furthered the criminal
activity by funneling over $1 million in surgery center cash assets into his
account to prevent it from being seized. In the three months following the
search of Unity, he laundered as much as $3 million into the attorney client
trust account using fraudulently billed payments from insurance companies to
keep the surgery center operating.
Accountant
Harnen, a Unity bookkeeper and profit shareholder, signed 10 checks to doctors
totaling over $50,000 and 157 checks to cappers totaling almost $1 million for
their participation in the Unity scheme. He acted as an official representative
for several of the corporations used by Unity to hide their illegal scheme from
insurance companies, and was one of the bank signatories
Harnen
assisted cappers and administrators in hiding their illegal activities by
helping them funnel money to corporations that he helped them to create with
the intention of hiding income and avoiding detection of their crimes. Harnen
helped Unity continue to illegally recruit "patients" and defraud
insurance companies using his own corporation to pay cappers and distribute
profits to shareholders. Harnen failed to report more than $6 million in income
over a 3-year period by failing to file tax returns and filing false tax
returns.
Landon
and Francis were clinic administrators and recruited doctors and cappers. They
ran the Unity facility, coordinated the fraudulent surgeries, sent all facility
billings, received payments from insurance companies on fraudulent billings,
and received and paid capper invoices for patient procedures.
Administrators
Pham, Ngo, and Nguyen pleaded guilty to performing the same roles in the scheme.
Senior
Deputy District Attorney William Overtoom and Deputy District Attorney George
McFetridge of the Major Fraud Unit are prosecuting all of the defendants in
this case