Twelve Arrested for Overbilling Insurers, Fraud

Twelve suspects in California have been arrested on felony insurance fraud charges. The arrests were the result of a three-and-a-half year investigation into Accident Help Line Medical Group (Accident Help Line) for insurance fraud.

The arrests were made by investigators from the California Department of Insurance’s (CDI) Fraud Division, as well as the Fresno and Kings County District Attorneys’ offices. Undercover operatives and investigators had found that various Accident Help Line clinics in Hanford, Fresno and Merced allegedly provided excessive and unnecessary treatment to patients for the purpose of over billing insurance companies.They also allegedly prescribed excessive Total Temporary Disability time off work to patients covered by workers’ comp insurance.

The investigation resulted in the arrests of six licensed chiropractors, a doctor of osteopathy, a physician’s assistant, and four other clinic workers – all employees of Accident Help Line. They include:

Charles Richard Affatato, DC, 34, of San Francisco, who was booked into the San Francisco County Jail; William Edward Sheaffer, P.A., 60, of Hanford, who was booked into the Kings County Jail; Marisela Vargas-Montes, 40, and Jason Everett Walker, 35, both of Fresno, and Ralph Gregory Howell, DC, 58, of Clovis, were all booked into the Fresno County Jail; Lorene Louise Hebert, DC, QME, 45, of Raymond, Emma Mendez-Defarless, 25, of Fresno, and Mark Peter Lungren, DC, 34, of Kingsburg, all surrendered to the Merced Superior Court. Mikel R. Meyer, D.O., 50, of Sparks, NV, surrendered to the South Lake Tahoe Police Department. Eva Soria Prieto, 22, of Orange Cove; Ronald Wayne Richards, 58, of Fresno; and Elizabeth Rodriguez, 27, of Fresno, all surrendered to the Fresno County Jail. Each suspect was booked in jail with $100,000 bail.

The Merced County District Attorney’s office filed a criminal complaint charging the 12 suspects with multiple felony counts of insurance fraud-related charges. Charges include: felony violations of conspiracy to commit insurance fraud; presenting or causing to present any false or fraudulent written or oral material statement in support of, or in opposition to, any claim for compensation for the purpose of obtaining or denying any compensation; and assisting in the presentation of a knowingly false or fraudulent written or oral material statement in support of, or in opposition to, any claim for compensation for the purpose of obtaining or denying any compensation.

Accident Help Line came to the attention of CDI investigators through complaints, tips and information received from the Special Investigative Units (SIU) of Geico and Zenith Insurance Companies, State Compensation Insurance Fund (SCIF), and other insurance carriers. Since late 2002, investigators have received numerous suspected fraud referrals accounting for millions of dollars in suspected workers’ compensation insurance fraud.

Based on the number of complaints, the Fresno Regional Office of the CDI, and the District Attorneys’ Offices in Merced, Fresno and Kings Counties initiated an undercover investigation of Accident Help Line. The SIUs of Geico and Zenith Insurance Companies, SCIF and other insurance carriers, as well as Foster Farms also assisted in the investigation.

The Merced County District Attorney’s office is prosecuting this case.

Source: CDI