Do you think the longshoremen who got tummy tucks for their wives (or girl friends) will have to pay it back?<\/p>\n
FOR IMMEDIATE RELEASE<\/em><\/p>\n March 6, 2015<\/em><\/p>\n SANTA ANA, California \u2013A federal jury has convicted two Southern California residents in connection with a scheme to defraud union and private health insurance programs by submitting bills for more than $71 million \u2013 and receiving over $50 million in payments \u2013 for medically unnecessary procedures performed on insurance beneficiaries who received free or discounted cosmetic surgeries.<\/em><\/p>\n \u00a0<\/em>A large number of the fraudulent claims were submitted to the International Longshore and Warehouse Union and Operating Engineers Union health insurance plans. Other victim insurers included Aetna and Anthem.<\/em><\/p>\n \u00a0<\/em>The two defendants found guilty yesterday are:<\/em><\/p>\n Theresa Fisher, 45, of Tustin, who was found guilty of five counts of mail fraud; and Lindsay Hardgraves, 30, of San Pedro, who was found guilty of two counts of mail fraud.<\/em><\/p>\n \u00a0<\/em>The evidence presented during a six-day trial showed that members of the scheme lured insured \u201cpatients\u201d to a surgery center in Orange with promises that they could use their union or PPO health insurance plans to pay for cosmetic surgeries, which are generally not covered by insurance. The surgery center was known at various times as Princess Cosmetic Surgery, Vista Surgical Center, and Empire Surgical Center.<\/em><\/p>\n \u00a0<\/em>Marketers such as Hardgraves referred \u201cpatients\u201d to the surgery center, where they were told they could receive free or discounted cosmetic surgeries if they underwent multiple, medically unnecessary procedures that would be billed to their union or PPO health care benefit program. Fisher was a consultant at the surgery center who scheduled procedures after telling the \u201cpatients\u201d about the free cosmetic procedures they could receive and coaching them to fabricate or exaggerate symptoms so that their medical procedures would be covered by their insurance.<\/em><\/p>\n \u00a0<\/em>The unnecessary procedures typically performed on the \u201cpatients\u201d were endoscopies (usually sophagogastroduodenoscopies, or EGDs), colonoscopies and cystoscopies. Once the health care benefit program paid the claims, the patients were given free or discounted cosmetic surgeries, including \u201ctummy tucks,\u201d breast augmentations and liposuction. In some cases, the surgery center simply billed cosmetic procedures (such as tummy tucks) as if they were medically necessary procedures (such as hernia surgeries).<\/em><\/p>\n \u00a0<\/em>Fisher and Hardgraves are scheduled to be sentenced by United States District Judge Josephine L. Staton on May 29.<\/em><\/p>\n \u00a0<\/em>A third defendant in this case \u2013 Vi Nguyen, 31, of Placentia, another consultant at the surgery center \u2013 pleaded guilty in January to four counts of mail fraud and faces sentencing before Judge Staton on July 10.<\/em><\/p>\n \u00a0<\/em>At sentencing, each defendant faces a statutory maximum sentence of 20 years in federal prison for each count of mail fraud.<\/em><\/p>\n \u00a0<\/em>This case is the product of an ongoing investigation by the Federal Bureau of Investigation, the United States Department of Labor \u2013 Office of Inspector General, the United States Department of Labor \u2013 Employee Benefits Security Administration, and the Office of Personnel Management \u2013 Office of Inspector General.<\/em><\/p>\n \u00a0<\/em>Release No. 15-023<\/em><\/p>\n \u00a0<\/em>If I were Jerry Avila or Chris Viramontes, I would be worried.<\/p>\n Or, is this a case of never mind, they are longshoremen, they can do anything and get away with it?<\/p>\n Time will tell.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Do you think the longshoremen who got tummy tucks for their wives (or girl friends) will have to pay it back? FOR IMMEDIATE RELEASE March 6, 2015 SANTA ANA, California –A federal jury has convicted two Southern California residents in connection with a scheme to defraud union and private health insurance programs by submitting bills … Continue reading “Two Found Guilty in Scheme that Bilked ILWU Insurance Plan Millions for Unneeded Medical Procedures”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1560","post","type-post","status-publish","format-standard","hentry","category-default"],"_links":{"self":[{"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=\/wp\/v2\/posts\/1560","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1560"}],"version-history":[{"count":3,"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=\/wp\/v2\/posts\/1560\/revisions"}],"predecessor-version":[{"id":1565,"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=\/wp\/v2\/posts\/1560\/revisions\/1565"}],"wp:attachment":[{"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1560"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1560"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/longshore-labor-relations.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1560"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}