Compliance

Medical Clinic Owners Plead No Contest to $60 Million Workers Compensation Fraud

By Staff Report

Feb. 23, 2010

Two California medical clinic owners pleaded no contest to charges of compensation or inducement for referring clients for profit in connection with a scheme that authorities say involved filing $60 million in workers’ compensation medical liens and bills.


San Diego resident David Wayne Fish and Rancho Santa Fe, California, resident Birger Greg Bacino pleaded no contest to charges they made false and fraudulent workers’ comp claims in connection with their ownership of Premier Medical Management Systems Inc. Premier owned five clinics around Los Angeles and contracted with more than 100 medical providers, the California Department of Insurance said.


Investigators alleged that the pair purchased thousands of workers’ compensation client referrals from an attorney television advertising service. Clients were then sent to doctors who had a relationship with Premier, which would handle billing and collection work in return for a 50 percent fee for money they collected.


Clients were then sent to attorneys who had a business relationship with Fish and Bacino, investigators allege.


“Getting kickbacks for referring medical payments is illegal and drives up the costs in the system,” California Insurance Commissioner Steve Poizner said in a statement.


As part of a negotiated settlement, Fish and Bacino will drop the $60 million in liens and bills pending before the California Workers’ Compensation Appeals Board and the insurance department will receive $900,000 as reimbursement for investigation costs.


The pair will serve three years of probation.


 


Filed by Roberto Ceniceros of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.


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