Indictment Alleges Workers Compensation Fraud at Illinois Clinic

A chiropractor, a medical doctor and a billing employee at a clinic owned by a chiropractor in Illinois were indicted on federal healthcare fraud charges, federal law enforcement officials announced.

 

The defendants allegedly illegally submitted false claims totaling more than $1 million to obtain payments from workers’ compensation and other insurers for services not provided and for inflated claims for provided services. The physician signed false documents and the chiropractor forged doctors’ signatures on documents supporting the false claims, according to an 18-count indictment returned by a federal grand jury.

Most of the patients of the clinic, the Spine and Joint Rehabilitation Center, were United States Postal Service employees who were eligible for benefits from the United States Labor Department’s Office of Workers’ Compensation Program.

 

Scott Caspall, special agent-in-charge of the Great Lakes Field Office of the U.S. Postal Service Office of Inspector General, noted, "Workers’ Compensation is a valuable healthcare program that provides a safety net to hardworking people injured on the job. This investigation is an effort to dismantle a group of medical providers and billers who the indictment alleges were abusing that program. In an age when individuals, businesses and the federal government are paying more for healthcare, this case is a prime example of the excellent results that come from combining the forces of federal law enforcement agencies."

 

According to the indictment, the defendants and others intentionally created and submitted false claims and information to the federal Workers’ Comp office and other health care insurers to obtain payment for the clinic and for patients. The false claims and information related to patients’ work-related injuries, including medical, diagnostic, and physical therapy services not provided or they  inflated provided services.

 

As part of the scheme, the defendant allegedly forged and caused others to forge physicians’  signatures on various documents falsely representing services, treatment, physical therapy and/or testing were provided, ordered or supervised by medical doctors. 

 

The defendant allegedly forged the doctors’ signatures, and caused them to sign reports without doing patient exams, knowing that Workers’ Comp would not accept a chiropractor’s opinions or reports as medical evidence to support patients’ claims.

 

Under the Federal Employees’ Compensation Act, chiropractors are not qualified physicians and their opinions did not constitute medical evidence except in very limited cases involving specific spine problems.

 

The defendant also falsely told patients he was qualified to prepare impairment rating reports and to order and provide testing and treatment. He failed to disclose that Workers’ Comp would not pay for services provided by a chiropractor except in very limited circumstances. The other defendant, et al  allegedly signed false documents making it appear the physician or another licensed physician had examined or treated patients.

 

The two defendants and others allegedly prepared false progress notes and fee sheets showing patient services were rendered when, in fact, they were not.  One defendant allegedly forged physicians’ signatures on claim forms certifying they were accurate, even though he knew many were false, including whether the services were provided and by whom.

 

He also prepared false itemized billing statements in personal injury cases to support payments to the clinic and patients. In addition, the two double-billed Workers’ Comp for disability exams the physician performed for which he received payment from every patient pay, so the clinic was paid twice for the same service, the indictment alleges. (workersxzcompxzkit)

 

Each count of health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine. If convicted, however, the Court would determine a reasonable sentence to impose under the United States Sentencing Guidelines advisory.