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Four people, including two physicians, charged with an estimated $17 million in work comp fraud

In recent workers' compensation defense news, four people - including two prominent physicians - are facing serious criminal charges for their alleged involvement in a work comp fraud scheme estimated by authorities to have netted nearly $17 million.

According to reports, charges were filed against Dr. Sim Carlisle Hoffman, a Newport Beach radiologist and the owner of three separate medical practices (Advanced Professional Imaging, Advanced Management Services and Better Sleeping Medical Center); Dr. Thomas Michael Heric, a Malibu neurologist who worked at Better Sleeping Medical Center; Louis Umberto Santillan, a bill collector for Advanced Professional Imaging; and Beverly Jane Mitchell, head of insurance billing for all of Dr. Hoffman's medical practices.

The California Department of Insurance (CDI) began investigating work comp billing practices at the named facilities back in July 2008 after the anti-fraud unit at Zenith Insurance Co. determined that Better Sleeping Medical Center was overbilling for medically unnecessary procedures and not following proper business practices.

The CDI eventually joined forces with the Orange County District Attorney and a subsequent joint investigation resulted in sealed grand jury indictments being handed down in May 2011 against all four defendants (unsealed just last week).

The two physician defendants are now facing the following charges:

  • Dr. Hoffman has been charged with 883 felony counts of insurance fraud (291 for Advanced Professional Imaging and 592 for Better Sleeping Medical Center) along with one felony count of aiding and abetting the unauthorized practice of medicine. If convicted, he faces anywhere from 2 to 892 years in state prison
  • Dr. Heric has been charged with 296 felony counts of insurance fraud along with one felony count of aiding and abetting the unauthorized practice of medicine. If convicted, he faces anywhere from 2 to 315 years in state prison

"The magnitude of the fraud committed by these co-conspirators is reprehensible," said Insurance Commissioner Dave Jones. "When medical providers conspire to defraud the California workers' compensation insurance system, everybody loses, including the injured workers and the businesses that employ them."

Stay tuned for further developments in the area of workers' compensation defense law ...

This post was provided for informational purposes only and is not to be construed as legal or medical advice. All suspects are innocent until proven guilty.

Related Resources:

Newport Beach doctor could face 800 years in prison for workers' comp scheme (Los Angeles Business Journal)

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