State Insurance Commissioner Dave Jones and county District Attorney Tony Rackauckas said Tuesday the DA’s office charged 26 California medical professionals in a $40 million insurance fraud scheme that includes a Costa Mesa pharmacy and four Orange County doctors.
“Insurance fraud is often times referred to as a victimless crime, but as you can see from this case, there are many victims,” Jones told a news conference where the charges were announced. According to a news release, 13,000 patients and 27 insurance carriers were victims of the scheme between 2011 and 2015.
“Now these are very egregious crimes when the health of individuals is put at risk because the physician is getting a kickback and that kickback is determining whether they are prescribing medications,” Jones said. “That undermines the very system of medical care.”
Tanya and Christopher King of Beverly Hills, owners of medical billing and management companies Monarch Medical Group, Inc. King Medical Management, Inc. and One Source Laboratories are accused of masterminding the scheme that billed insurance companies $40 million of which the Kings received $23 million and paid physicians and pharmacists.
In addition to the Kings, charges were filed against 21 doctors from throughout the state, one physician’s assistant and two pharmacists.
Pharmacists Charles Bonner, 56 and Mervyn Miller, 66, both of Irvine, are accused of conspiring with the Kings and selling more than $1 million in creams that have no known medical benefits and are not FDA approved. They are co-owners of Steven’s Pharmacy in Costa Mesa.
Tanya King recruited doctors to prescribe the creams to their patients by either paying the physicians a flat rate of $50 per tube or a share in the profits, according to a news release.
“Fraud, as you know, drives up the cost of medical care … and affects the ability to conduct business in California. And so, you know, we really do need to stay on top of it,” Rackauckas told the news conference.
The Kings bought the creams from Steve’s Pharmacy, which, according to the DA and Jones, mass produced thousands of creams at $15 to $40 per tube and paid doctors for prescribing them. The patients’ workers’ compensation insurance was billed anywhere from $250 to $700 for each tube whenever a doctor prescribed it for a patient, according to the DA’s office.
The DA’s office also is accusing the Kings of running a kickback scam that involved repackaging oral pain medication from NuCare Pharmaceuticals in Orange and AS Medication Solutions in Costa Mesa.
The medication was sent directly to the doctors who prescribed it and was billed to workers’ compensation insurance companies without the Kings disclosing to the insurers the wholesale cost of the medication or the fact it was bought on behalf of the prescribing doctors.
“This primal conduct helps drive the … price of insurance up,” Rackauckas said. “Not exactly a mystery on why our medical premiums are so high.”
The third scheme that state insurance investigators and DA’s office said they found was bogus urine tests. Doctors used King-owned One Source Laboratories to unnecessarily test their patients who had workers compensation insurance to make sure they were taking their prescriptions, Rackauckas said.
Regardless of the results from the King’s One Source Lab, the results were sent to Pacific Toxicology Laboratory for additional testing. Through their One Source Lab, the Kings paid Pacific a flat rate of $60 per test and billed insurance companies hundreds of dollars per patient.
“Not satisfied with the profits of one test, the results were then referred to Pacific Toxicology Laboratory for additional testing, regardless of the results,” Rackauckas said.
Tanya King could face up to 117 years in prison. No estimated sentence was given for Christopher King. Pharmacists Bonner and Miller each could get up to a 28-year sentence and the 21 physicians and one physician assistant could face up to 25 years in prison.
“They violated their oath as physicians and they violated the law,” Jones said.
The four Orange County doctors among the 21 physicians charged are: Dr. Duke Anh, 49, Los Alamitos, received $80,000; Dr. Kevin Park, 49, Buena Park, was paid $45,000; Dr. Ismael Silva Jr., 63, Newport Coast, received $345,000, and Dr. Ismael Geli Silva, 38, Huntington Beach, made $345,000.
In total, the investigation alleges over $2.1 million was paid to the 21 physicians.
Spencer Custodio is a Voice of OC intern. He can be reached at email@example.com.