Owners And Staff Of Louisville Area Chiropractic Clinics Charged With Health Care Fraud And Identity Theft
Fraudulently Billed Insurance Companies $5 million for Services Never Performed
LOUISVILLE, Ky. – Acting United States Attorney John E. Kuhn, Jr. today announced the indictment and arrests of owners and staff of Louisville area chiropractic clinics and a medical billing corporation on charges of health care fraud and identity theft. The scheme involved unsuspecting chiropractors, patients, insurance companies, and area employers – namely Jeffboat, LLC located in Jeffersonville, Indiana. Over an eight-month-long period, the defendants are accused of scheming to fraudulently bill insurance companies $5 million for services never performed that cost Jeffboat a loss of approximately $1.3 million.
According to the eight count indictment, beginning no later than November 25, 2013, and continuing through July 18, 2014, five named defendants recruited unsuspecting chiropractors to either open chiropractic clinics or to staff existing chiropractic clinics in the Louisville area. Their intent was to fraudulently bill insurance companies from the clinics.Each chiropractor provided his/her National Provider Identifier (NPI) number to defendants Claudia Lopez and Oskel Lezcano in order to credential the clinics with various insurance companies.Thereafter, the defendants recruited employees from Jeffboat and others to seek chiropractic services from the clinics.However, unbeknownst to the patients and the chiropractors, the clinics billed over $5,000,000 for methocarbamol injections (a muscle relaxant),using the patients’ names, dates of birth, insurance/policy numbers, addresses, and patient IDs/Social Security Numbers without the patients’ knowledge and for injections that were never provided.
The clinics used Lezcano’s billing companies, Gold Hands Medical Billing Corp and Gold Hands Medical Billing B, Inc., to process the fraudulent billings for payment through Jeffboat’s third-party administrator, United Health Care Services, Inc. In addition, multiple clinics billed for the fraudulent injections using the same patients’ names.
Claudia Lopez, Oskel Lezcano, Ariel Borrego-Hernandez, Sergio Betancourt, and Ledinson Chavez operated and controlled multiple chiropractic clinics in the Louisville area including: Xpress Diagnostics Center, Inc.; Prudential Chiropractic Medical Center, PLLC; Klondike Chiropractic Medical Center, LLC; Be Well Chiropractic Center, Corp.; Chiropractic and Medical Center, LLC, even though the clinics were placed in various chiropractors’ names.
All five defendants are charged with one count of health care fraud. Lopez and Lezcano are both charged with additional counts of aggravated identity theft. If convicted at trial, the defendants could be sentenced to no more than ten years in prison, a $250,000 fine and a three year period of supervised release. Defendant Lopez could be sentenced to an additional 4 years in prison and fined an additional $500,000 for a conviction on the identity theft charges.Defendant Lezcano could be sentenced to an additional 10 years in prison and fined an additional $500,000 for a conviction on the identity theft charges.
This case is being prosecuted by Assistant United States Attorneys Joseph Ansari and Lettricea Jefferson-Webb and is being investigated by the Federal Bureau of Investigation (FBI), the United States Postal Inspection Service, the Internal Revenue Service Criminal Investigation, the Louisville Metro Police Department and the National Insurance Crime Bureau.
The indictment of a person by a Grand Jury is an accusation only and that person is presumed innocent until and unless proven guilty.