SANTA ANA, California –A federal jury has convicted two Southern California residents in connection with a scheme to defraud union and private health insurance programs by submitting bills for more than $71 million – and receiving over $50 million in payments – for medically unnecessary procedures performed on insurance beneficiaries who received free or discounted cosmetic surgeries.
A large number of the fraudulent claims were submitted to the International Longshore and Warehouse Union and Operating Engineers Union health insurance plans. Other victim insurers included Aetna and Anthem.
The two defendants found guilty yesterday are:
Theresa Fisher, 45, of Tustin, who was found guilty of five counts of mail fraud; and
Lindsay Hardgraves, 30, of San Pedro, who was found guilty of two counts of mail fraud.
The evidence presented during a six-day trial showed that members of the scheme lured insured “patients” to a surgery center in Orange with promises that they could use their union or PPO health insurance plans to pay for cosmetic surgeries, which are generally not covered by insurance. The surgery center was known at various times as Princess Cosmetic Surgery, Vista Surgical Center, and Empire Surgical Center.
Marketers such as Hardgraves referred “patients” to the surgery center, where they were told they could receive free or discounted cosmetic surgeries if they underwent multiple, medically unnecessary procedures that would be billed to their union or PPO health care benefit program. Fisher was a consultant at the surgery center who scheduled procedures after telling the “patients” about the free cosmetic procedures they could receive and coaching them to fabricate or exaggerate symptoms so that their medical procedures would be covered by their insurance.
The unnecessary procedures typically performed on the “patients” were endoscopies (usually sophagogastroduodenoscopies, or EGDs), colonoscopies and cystoscopies. Once the health care benefit program paid the claims, the patients were given free or discounted cosmetic surgeries, including “tummy tucks,” breast augmentations and liposuction. In some cases, the surgery center simply billed cosmetic procedures (such as tummy tucks) as if they were medically necessary procedures (such as hernia surgeries).
Fisher and Hardgraves are scheduled to be sentenced by United States District Judge Josephine L. Staton on May 29.
A third defendant in this case – Vi Nguyen, 31, of Placentia, another consultant at the surgery center – pleaded guilty in January to four counts of mail fraud and faces sentencing before Judge Staton on July 10.
At sentencing, each defendant faces a statutory maximum sentence of 20 years in federal prison for each count of mail fraud.
This case is the product of an ongoing investigation by the Federal Bureau of Investigation, the United States Department of Labor – Office of Inspector General, the United States Department of Labor – Employee Benefits Security Administration, and the Office of Personnel Management – Office of Inspector General.
Sponsored Posts 3 Reasons Why Eating Wheat is Killing You – Read Exclusive Movie Deals Online Natural ED Treatment
LawFuell's editors select and publish the most relevant and up-to-date information about lawyers and law firms for LawFuel on a daily basis from the most reputable and independent sources available.
Foley & Lardner – Yesterday marked the sunrise launch of the .porn and .adult generic top-level domains (gTLDs), which join .xxx in the top-level domain name space as gTLDs targeted mainly at online purveyors of adult entertainment. As with .xxx, the introduction of these adult-themed gTLDs presents yet another annoyance for trademark owners already fatigued by the weekly onslaught of gTLDs introduced over the past couple of years pursuant to ICANN’s expansion of the domain name space. Also as with .xxx, brand owners have some opportunities to defensively register .adult and .porn domain names early in the life of these new gTLDs.
ICM Registry, the operator of this titillating trifecta of gTLDs, intended that trademark owners who secured “blocking” registrations of .xxx domains would receive free matching registrations for corresponding domains in the .porn and .adult. (and the forthcoming .sex) gTLDs. However, this plan fell through, and brand owners must once again pony up registration fees. They generally have three options prior to general availability of .porn and .adult domains.
1. Trademark Clearinghouse Sunrise Period. From March 2, 2015 to April 1, 2015, trademark owners that have trademarks recorded in the Trademark Clearinghouse can register corresponding .porn and .adult domains in the same manner that they can register in the sunrise periods of other newly launched top-level domains.
2. Sunrise B. From April 6, 2015 to April 30, 2015, trademark owners that already own a matching .xxx registration can register .porn and .adult domains.
3. Domain Matching. From May 6, 2015 to May 31, 2015, anyone that owns a .xxx domain registered by April 30, 2015 can register matching .porn and .adult domains.
General availability of .porn and .adult domains opens on June 4, 2015, when domains can be registered by anyone on a first-come, first-served basis. Certainly, trademark owners — and especially the owners of famous brands — concerned about potentially harmful third-party .porn and .adult registrations should consider registering their brand.porn and brand.adult domains during one of the two sunrise phases, if they’re eligible, and if not then at some point thereafter.
While .porn and .adult are less in-your-face than .xxx, they are arguably more likely to give brand owners headaches. Unlike .xxx, registration in the these new gTLDs isn’t limited to purveyors of adult entertainment — they are available to all. Further, both .porn and .adult have meanings beyond sex. “Porn” is often used colloquially to refer to enticing and “explicit” visual presentation of things other than naked humans, such as food and cars, and “adult” has widespread applicability beyond pornography. For all of these reasons, there’s a good chance these domains could be more popular than .xxx, and they are probably more likely to be abused or at least registered and used in a manner that may conflict with trademarks.
The .Sex gTLD is expected to launch this fall, and the same registration options for brand owners should be available at that time.
[table id=9 /]
LawFuell's editors select and publish the most relevant and up-to-date information about lawyers and law firms for LawFuel on a daily basis from the most reputable and independent sources available.