Five Modesto doctors are among more than two dozen physicians, pharmacists, business owners and a physician assistant charged in a $40 million fraudulent medical billing and kickback scheme, authorities announced Thursday.
State Insurance Commissioner Dave Jones and Orange County District Attorney Tony Rackauckas said a Beverly Hills couple are accused of masterminding a complex insurance fraud scheme of recruiting doctors and pharmacists to prescribe unnecessary treatment for workers compensation insurance patients.
Authorities allege the scam took place from 2011 to 2015 and involved more than 13,000 patients. Authorities said $40 million was billed to insurance companies, and the defendants were paid about $23.2 million.
Stanislaus Orthopaedic and Sports Medicine Clinic physicians Jonathan Louis Cohen, 57, John Joseph Casey Jr., 65, Mohamed Adly Ibrahim, 40, and William Louis Pistel, 53, are among those charged. Authorities identified all of them as Modesto physicians except for Ibrahim, who authorities said is from Danville.
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A receptionist in Caton’s office said he had no comment. A receptionist in Robson’s office said he was not available for comment. Requests made in the Stanislaus Orthopaedic and Sports Medicine Clinic office and by email to its director seeking comment were not answered Thursday afternoon.
Tanya Moreland King and husband Christopher King own the medical billing and medical management companies Monarch Medical Group Inc., King Medical Management Inc. and One Source Laboratories Inc.
Irvine pharmacists Charles Bonner and Mervyn Miller own Steven’s Pharmacy and are accused of conspiring with the Kings by selling more than $1 million in compound creams that were not FDA approved nor have any known medical benefits, according to a Department of Insurance-Orange County district attorney’s office news release.
“The Kings and their co-conspirators played with patients’ lives, buying and selling them for profit without regard to patient safety,” Jones said in the news release. “Patients have the right to expect treatment decisions by health care professionals are based on medical need and not unadulterated greed. The magnitude of this alleged crime is an affront to ethical medical professionals.”
The Kings are accused of making oral and written agreements with physicians across the state, paying them each time they prescribed a compound cream or oral medication or ordered a urine drug test, according to the news release. The doctors or the companies connected to them are accused of labeling the payments “marketing expenses” in an attempt to conceal the kickbacks. The Kings are accused of rewarding doctors who provided higher volume by paying for office technicians.
The news release claims the Kings purchased the creams from Steven’s Pharmacy for $15 to $40 per tube, but workers compensation insurance carriers were billed $250 to $700 for each tube. The Kings also are accused of a scam involving the purchase and repackaging of oral pain medication and splitting the profits with the physicians.
Authorities allege Caton and Robson each received $175,000 in kickbacks and the four Stanislaus Orthopaedic and Sports Medicine Clinic physicians received a combined $248,000 in kickbacks.
Caton and Robson and the Stanislaus Orthopedic physicians are charged with conspiracy to commit medical insurance fraud; filing false and fraudulent claims; taking rebates for patient referrals; and insurance fraud.
Authorities said most of the 21 doctors who were charged are from Southern California, with some from the Bay Area and Sacramento region. The Modesto doctors are the only ones from the Northern San Joaquin Valley.
Kevin Valine: 209-578-2316
At a glance
John J. Casey Jr., board-certified orthopedic surgeon, Stanislaus Orthopaedic and Sports Medicine Clinic, 609 E. Orangeburg Ave. Casey is affiliated with Doctors Medical Center. 1977 graduate of Universidad Autonoma de Guadalajara, Guadalajara, Jalisco, Mexico. Bail recommendation on charges he faces: $200,000.
Robert E. Caton, specializes in orthopedic surgery, practice at the Fifteen 24 Professional Center, 1524 McHenry Ave. Caton is affiliated with Doctors and Memorial medical centers. 1980 graduate of the University of South Alabama College of Medicine in Mobile. Bail recommendation: $175,000.
Jonathan L. Cohen, specializes in orthopedic surgery and orthopedic sports medicine, Stanislaus Orthopaedic and Sports Medicine Clinic. Cohen is affiliated with Doctors Medical Center. 1985 graduate of the Tulane University School of Medicine in New Orleans. Bail recommendation: $200,000.
Mohamed A. Ibrahim, specializes in hand surgery, Stanislaus Orthopaedic and Sports Medicine Clinic. Ibrahim is affiliated with Doctors Medical Center. 2001 graduate of the Ain Shams University School of Medicine, Abbasia, Cairo, Egypt. Bail recommendation: $200,000.
William L. Pistel, specializes in orthopedic surgery and orthopedic sports medicine, Stanislaus Orthopaedic and Sports Medicine Clinic. Pistel is affiliated with Doctors Medical Center. 1991 graduate of the University of North Texas College of Osteopathic Medicine in Fort Worth. Bail recommendation: $200,000.
Jerome A. Robson, specializes in anesthesiology and pain management, practice at 500 Coffee Road. Robson is affiliated with Doctors Medical Center. Graduate of the Stanford University School of Medicine in 1974. Bail recommendation: $65,000.
Sources: WebMD.com and court documents