The California Department of Insurance teamed with the Federal Bureau of Investigation and the Kern County District Attorney's Office in a health care fraud investigation that has resulted in the arrest of two chiropractors, one in Los Angeles and the other in Bakersfield, and the pending arrest of a clinical psychologist. The three are charged with 15 counts of health care fraud and conspiracy to commit health care fraud.
On July 9, 2015, Chiropractor Bahar Gharib-Danesh, 38, of Woodland Hills, was arrested in Los Angeles; Chiropractor Na Young Eoh, 41, of Bakersfield, was arrested in Bakersfield; and clinical psychologist John Terrence, 72, of Marina Del Rey, is expected to voluntarily appear before the U.S. District Court in Fresno within the next 30 days.
“Identifying and prosecuting fraud in the provision of health care services is a priority for this office,” said U.S. Attorney Wagner. “We will continue to work with our federal and state partners in pursuing dishonest health care providers who plunder public and private health care insurance plans for their own gain.”
"California Insurance Commissioner Dave Jones and his team of investigators are relentless when it comes to investigating insurance fraud," said California Statewide Law Enforcement Association (CSLEA) President Alan Barcelona. "California is plagued with unscrupulous people who steal by falsifying information. As local, state and federal agencies team up to combat this, my hope is we start to see the number of insurance fraud cases diminish."
According to an indictment returned on July 2, 2015, Gharib-Danesh was a chiropractor and the manager of Pain Relief Health Centers (PRHC). PRHC was headquartered in Los Angeles and had clinics in Bakersfield, Visalia and Fresno, as well as in Los Angeles County. Eoh was also a chiropractor and was the treating physician for PRHC’s Kern County workers’ compensation claims. Terrence was a clinical psychologist who saw patients from the Bakersfield clinic.
According to the indictment, PRHC recruited patients who were workers claiming to have an injury. In treating the patients, Gharib-Danesh instructed her staff to add as many injured body parts for treatment as possible to generate higher billings. The treatment plan generally included shock wave therapy, electro stimulation therapy, myo-facial release/massage, physical therapy, chiropractic manipulation, compound creams, and psychological evaluation. Nearly every patient was scheduled for the same treatments, and the maximum amount of treatments allowed by law was generally billed to the insurance company. Eoh operated out of the Bakersfield Clinic, the Visalia Clinic, and the Fresno Clinic and would sign the treatment plans and referral forms.
If the claim of injury was denied by the insurance company, a lien would be filed, and the claims would either be litigated before the California Workers’ Compensation Appeals Board or be settled by negotiations through the parties. Lien settlements for less than the full amount of the claim were acceptable because of the high volume of patients recruited and by the large amount of medical fees generated.
The indictment further alleges that Gharib-Danesh directed Eoh to refer all patients who came into the clinic to Terrence for a psychological evaluation, regardless of the injury the patient reported. Terrence submitted bills and reports for each patient that were virtually identical. He also allegedly fraudulently billed for patients at a rate higher than legally allowed. According to the indictment, Terrence provided each patient with approximately 20.8 hours of psychological evaluations in a single day. On one day, Terrence billed a total of 291.2 hours for treating 14 patients. In one period of two weeks, Terrence billed over a thousand hours treating patients and writing reports. Between 2005 and 2012, Terrence submitted claims for psychological services in workers’ compensation cases totaling in excess of $5.6 million.
This case investigation was conducted by the Federal Bureau of Investigation, the California Department of Insurance, and the Kern County District Attorney’s Office.
If convicted, each defendant faces a maximum statutory penalty of 20 years in prison and a $250,000 fine on each count of the indictment.