Doctor Charged with Insurance Fraud

An Illinois and Michigan doctor has been indicted by a federal grand jury for criminal insurance fraud including multiple counts of health care fraud, making false statements and aggravated identity theft. According to a white collar criminal defense attorney, each count of health care fraud, a form of insurance fraud, carries a maximum penalty of 10 years in prison and a $250,000 fine, as well as forfeiture of assets for restitution.

One of the doctor’s nurse assistants, Jeanette Shin, has also been charged as a co-defendant with allegedly making false statements in medical reports.  According to the indictment, the alleged health care fraud scheme involved more than $3 Million in false medical claims by the doctor’s practice.

Dr. Paul Madison, a pain management specialist, operated an outpatient facility known as Watertower SurgiCenter, LLC, which is where the alleged fraud is claimed to have been initiated.

According the U.S. Attorney Dr. Madison instructed his staff to submit fraudulent invoices to insurance companies for procedures that were never performed.  The U.S. Attorney further alleges that Dr. Madison attempted to cover up this healthcare fraud scheme by creating false records to reflect that the procedures had, in fact, been performed.  A common explanation often given by healthcare professionals under investigation is that the offense is the result of sloppy bookkeeping, and not healthcare fraud.  Often the procedures for which the doctor billed were in fact actually performed, just not on the date invoiced.

However, the U.S. Attorney has also alleged that the doctor destroyed patient files and replaced them with the fake reports in further attempt to cover the fraudulent insurance billing practices.  It is unknown the proof of this allegation.

The U.S. Attorney’s office claims in excess of $3 million was stolen by fake invoices for medical services not provided from Blue Cross Blue Shield of Illinois, Hartford Insurance Co. and numerous other insurance companies.

Cases such as Dr. Madison’s are often reported by patients, who receive reports of services provided from their insurer and do not recognize the procedures listed.  These patients often then contact their insurance company, who will then launch an investigation.  It is also not uncommon for doctors and other medical professionals to have employees (or former employees) contact the authorities to complain about alleged billing improprieties.  Often the employee is disgruntled and seeking revenge, or is seeking financial compensation as a whistle blower.  It is not known how Dr. Madison came under investigation.

Dr. Madison and Ms. Shin are innocent until they have been proven guilty.

If you find yourself facing federal fraud charges, it is important to find an experienced insurance fraud attorney to represent you.  The white collar criminal attorneys of Parkman & White, LLC have a history of success in the court room and are ready to represent clients nationwide.



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