Chiropractic Insurance Fraud Conspiracies Cracked by Minnesota Commerce Fraud Bureau and FBI

[nitpicker]

https://www.justice.gov/usao-mn/pr/chiropractic-insurance-fraud-conspiracies-cracked-minnesota-commerce-fraud-bureau-and-fbi

Department of Justice
U.S. Attorney’s Office
District of Minnesota

FOR IMMEDIATE RELEASE
Wednesday, December 21, 2016

Chiropractic Insurance Fraud Conspiracies Cracked by Minnesota Commerce Fraud Bureau and FBI

Chiropractors billed “no-fault” insurance policies for more than $20 million dollars

United States Attorney Andrew M. Luger today announced federal criminal charges filed against 21 defendants for conspiring to commit health care fraud. The defendants, charged by four indictments and two felony informations, fraudulently billed insurance companies for millions of dollars over the course of the parallel conspiracies.
(snip)

Under the Minnesota No-Fault Automobile Insurance Act, auto insurance policies must include a personal injury protection provision (PIP). The PIP provision carries a minimum coverage amount of $40,000 for expenses resulting from injuries sustained in an automobile accident, $20,000 of which may be used for medical expenses.

According to the charging documents, at various times between at least 2010 and 2015, chiropractors PRESTON E. FORTHUN, ANGELA A. SCHULZ, HUY NGOC NGUYEN, ADAM J. BURKE, and other Doctors of Chiropractic, engaged in schemes with others to defraud automobile insurance companies. The schemes, which were nearly identical fraud schemes largely carried out independent of one another, involved the submission of fraudulent no-fault insurance claims.

According to the charging documents, chiropractors involved in the scheme would submit claims and receive reimbursements for chiropractic services that either were not medically necessary or were never rendered. Each chiropractor would prescribe and purportedly provide services that were not determined medically necessary by the physical condition of each patient, but were instead designed to fraudulently maximize reimbursement from the patients’ automobile insurance companies.

According to the charging documents, in order to get more patients to come to chiropractic appointments for treatment they did not need, the chiropractors charged would make illegal payments to patient recruiters, known as “runners.” Runners typically made upwards of $1,000 per automobile accident patient in exchange for bringing the patient into the chiropractor’s office. Runners were often not paid, or paid only in part, until after the patient had attended a minimum threshold number of treatment sessions. In order to keep the patients coming back for medically unnecessary appointments, the runners often paid illegal kickbacks to the patients.
(snip)

[The Velveteen Ocelot]

1. I've been hearing about these crooked chiropractor schemes for years.

They'd use these "runners" to recruit patients, and then they'd tell patients they needed more "adjustments" to keep them coming back. This kind of thing was going on 30 years ago, but usually on a smaller scale so they were rarely caught. Plaintiffs' lawyers and the insurers knew about it, though, and the lawyers would often advise their clients to avoid chiropractors and go to real doctors for treatment because the insurance companies knew what the chiropractors were up to and sometimes wouldn't pay the bills.