Kudos to our California Statewide Law Enforcement Association members (CSLEA) with the California Department of Insurance, the California Dental Board and the California Franchise Tax Board, whose investigations resulted in jail time for a Beverly Hills dentist who pleaded no contest to insurance fraud and failing to file income tax returns.
According to the Los Angeles County District Attorney's Office, on April 29, 2014, a Los Angeles County Superior Court judge sentenced Tom K. Kalili, 59, to a year in jail and five years formal probation. In addition, the Beverly Hills dentist paid more than $780,000 in restitution.
"Much to the infuriation of consumers, this type of illegal activity affects all of us who pay insurance premiums," said CSLEA President Alan Barcelona. "Our detectives and investigators are committed to identifying these lawbreakers, no matter who they are, and conducting a top-notch investigation that leads to arrests, convictions, restitution and incarceration."
Kalili, the owner of Beverly Hills Medical Suites (BHMS), a dental office, was arrested in May 2012 following a multi-year, joint investigation by the three state agencies. According to a California Department of Insurance press release (May 4, 2012), Kalili was arrested on 113 felony counts including insurance fraud, filing false claims, grand theft and failure to file tax returns. The investigation revealed that BHMS submitted billing for services not rendered, in most cases the billing involved emergency dental procedures that were never performed. BHMS also submitted false medical reports in support of fraudulent billing, which generally included fictitious mechanisms of injury.
The investigation also revealed that Kalili submitted two fraudulent insurance claims on behalf of himself and his son to two automobile insurers. These claims included medical reports alleging he received treatment in auto accidents in 2005, 2008 and 2009 and his son for treatment received for injuries sustained in a 2009 auto accident. Detectives found that these medical reports were fraudulently prepared. The dentist listed as providing treatment for the injuries claimed by Kalili denied performing the services listed.
The investigation revealed that the total loss to the insurance carriers was $439,000.
On April 10, 2014, Kalili pleaded no contest to one felony count each of insurance fraud and failure to file income tax returns. Kalili also admitted excessive taking allegations of more than $150,000. If convicted of the original charges, Kalili faced up to 50 years in prison.
Kalili's former office manager and biller, Claudia Ventura, 40, was also arrested in 2012, and on April 10, 2014, pleaded no contest to two felony counts of insurance fraud. Ventura is expected to be sentenced on July 11 to 180 days of county jail, 200 hours of community service and five years formal probation.