A Malibu doctor has been indicted on 296 counts of insurance fraud, and the Newport radiologist who employed him has been indicted on more than 800 felony counts of insurance fraud.
CBS news and other media outlets reported that a grand jury indictment unsealed Monday accuses Dr. Sim Carlisle Hoffman, 59, of Newport Beach, Dr. Thomas Michael Heric, 74, of Malibu, Beverly Jane Mitchell, 60, of Westlake Village, and Louis Umberto Santillan, 44, of Chino Hills, of overbilling for unnecessary or never-performed procedures in a $17 million workers’ compensation insurance fraud scam.
Heric and the two other doctors worked for Hoffman in a Buena Park medical office.
Hoffman, a radiologist who owns Advanced Professional Imaging, Advanced Management Services and Better Sleeping Medical Center in Buena Park, is charged with 883 felony counts of insurance fraud and one felony count of aiding and abetting the unauthorized practice of medicine.
Mitchell, who administers insurance billing for Hoffman’s nerve and sleep testing centers, faces the same charges as Hoffman.
Heric, a neurologist, who worked for Hoffman at the Better Sleeping Medical Center, is charged with 296 counts of insurance fraud and one count of aiding and abetting the unauthorized practice of medicine.
Santillan, who did billing collections for Advanced Professional Imaging, is charged with 141 felony counts of insurance fraud.
“The mastermind of this medical mill is Dr. Sim Hoffman,” Orange County District Attorney Tony Rackauckas stated in the indictment. “Hoffman is a radiologist who owns the sleep and nerve testing centers. He is charged for using patients as props in order to bilk the system by overbilling the insurance companies.”
Rackauckas said the Medical Board of California disciplined Hoffman in 2001 for similar unethical medical practices.
Hoffman had Heric “study” patients and write reports on their status, Rackauckas said.
“Heric’s so-called `studying’ of patients involved using a made-up formula entirely of his own creation that is not recognized in any medical community,” Rackauckas said.
None of the patients were given any treatment for their disabilities, he said.
Heric’s license was suspended for 60 days in 2008 for a felony Medicare and Medi-Cal fraud conviction, Rackauckas said.
Patients went through painful nerve testing at a cost of $330 instead of a less painful $35 exam. Rackauckas said that only two doctors in California are qualified to conduct the more expensive and painful nerve testing, and Hoffman is not one of them.
Rackauckas alleges that the four “created a $17 million medical mill at the expense of over 1,200 patients and the workers’ compensation insurance system.”
The four were indicted May 11, but the grand jury indictments were not unsealed until today.