Participants in $200 Million Workers' Comp Scheme Sentenced to Prison and More Than $2 Million in Fi

[nitpicker]

https://www.justice.gov/usao-sdca/pr/participants-200-million-workers-comp-scheme-sentenced-prison-and-more-2-million

Department of Justice
U.S. Attorney’s Office
Southern District of California

FOR IMMEDIATE RELEASE
Friday, February 22, 2019

Participants in $200 Million Workers’ Comp Scheme Sentenced to Prison and More Than $2 Million in Financial Penalties

SAN DIEGO – This week in federal court a slew of conspirators involved in a massive Workers’ Compensation kickback scheme were ordered to serve prison sentences and pay millions in financial penalties for their roles in the corrupt payment of millions of dollars to induce doctors and other medical professionals to refer hundreds of injured workers for medical treatments and services.

According to court records, dozens of marketers, doctors, lawyers and medical service providers conspired to bilk the Workers’ Compensation system in California by buying and selling patients -- and their individual “body parts” -- like commodities. Among the defendants sentenced this week was an attorney, a chiropractor, two business owners and several marketers who referred patients for tests (such as MRIs, functional capacity exams and sleep studies), treatments (such as “shockwave,” x-rays, and ultrasound), pain medications, and durable medical equipment (DME) based on the corrupt payments. The conspirators often subjected patients to uncomfortable and sometimes painful procedures, so the conspirators could thereafter bill insurance companies for millions of dollars. As the government argued in its sentencing papers, the conspirators’ corruption of the doctor-patient relationship caused physicians to see price tags on every patient’s body parts. Each of the defendants played a critical role in the corrupt scheme.

Defendant Fermin Iglesias and co-defendant Carlos Arguello operated a patient-capping enterprise, in which they found individuals who would file Workers’ Compensation claims against their employers. Iglesias and Arguello then sold, bartered and exchanged these applicants with others in the Workers’ Compensation industry, including attorneys, primary care physicians, and providers of medical goods and services. Each of these entities had to “pay to play,” and as the patient was referred throughout this corrupt system, money changed hands at each step. Arguello operated several patient-recruitment entities, including one called Centro Legal. Through billboards, flyers, advertisements and business cards, Centro Legal recruited persons to seek workers' compensation benefits from their employers or former employers. When the injured worker called the 1-800 number on the billboard or card, he or she reached a call center, which might be located in another country. From there, Iglesias’ company, Providence Scheduling, took over brokering the patient to maximize the profit that could be extracted from him or her.

Centro Legal referred the newly-acquired patient to complicit Workers' Compensation attorneys, including, in San Diego, attorney Sean O’Keefe, who had one of the largest Workers’ Comp caseloads in the region. To get these new clients, the attorneys in the corrupt network were expected to comply with certain conditions: first, they had to use Arguello’s copying service to fulfil document requests for all of the new client’s medical records; second, they had to agree to designate as their client’s primary treating physician (“PTP”) one of the complicit physicians within the corrupt network. In exchange, the attorneys received compensation. For O'Keefe, the compensation took a variety of forms. One hospital administrator paid the salaries of two employees of O’Keefe’s law firm, as a kickback to O’Keefe for referring spinal surgeries to that hospital. In another variation, the kickback payments were disguised as payments for nonexistent legal services, for which O’Keefe generated phony “legal invoices” to cover up those obviously illegal payments.

The corrupt physician could serve as the patients' primary care physician in the Workers' Comp system. This was a key gatekeeper role, because the PTP was entrusted with the authority to determine what additional goods and services the patient needed. Iglesias required that the chiropractors prescribe a certain minimum quota of goods and services, on average, for each patient. If the chiropractor failed to live up to the quota, Iglesias would cut off the flow of new patients.

Dr. Steven Rigler was one of the chiropractors involved in the corrupt referral network. He had clinics in Calexico, San Diego, and Escondido. To get patients for his San Diego and Escondido clinics, Rigler agreed to meet the referral “quota” set by Iglesias and Arguello. Court records reflect that Iglesias set a “value” for each type of service the physicians could refer, for example, $30 for each MRI, and $150 for Durable Medical Equipment (DME), to meet the quota of $600. To get credit, physicians had to refer their DME orders to Iglesias’ company, Meridian Medical Resources. Many of the MRIs were referred to Advanced Radiology, a diagnostic imaging company owned by Dr. Ronald Grusd. In Calexico, Ruben Martinez ran Rigler’s clinic and managed all of Rigler’s referrals for ancillary services. Alexander K. Martinez performed the same service for Rigler’s other clinics.

If the physicians failed to meet the quota, Iglesias cut off the pipeline of new patients. Iglesias employed Miguel Morales to ensure that physicians met the quota, and to demand lump-sum payoffs from them if they failed to do so. And to avoid such problems, and ensure a smooth referral process, Arguello hired referral managers who worked in chiropractor offices. For a time, Julian Garcia was paid by Arguello to manage Rigler's referrals. Garcia had Rigler's signature stamp, and if Rigler got behind, Garcia would simply increase the number of MRIs referred for each patient. Eventually, Garcia himself got licensed as a DME provider, and he himself paid chiropractors $50 apiece to prescribe “hot/cold packs” for pain relief, which were then billed to insurance companies for nearly $6,000.

Jennifer Louise White represented providers of other types of services, namely, Autonomic Nervous System (“ANS”) studies and sleep studies. She worked with Alex Martinez and with providers of the ANS and sleep studies to pay nearly $200,000 in kickbacks to Rigler to refer patients for these services.
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[dixiegrrrrl]

1. Of course those are not the only group of people ripping off the health system.

I wish I had a dollar for every telephone call I get from Medicare scammers.
There are several ads in our weekly newspaper offering CPAP machines, other durable medical equipment covered by Medicare.