California Radiologist, Neurologist Charged With Insurance Fraud

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imageTwo physicians and two of their co-workers have been indicted for a $17 million workers’ compensation insurance overbilling scheme, the Orange County, Calif. District Attorney’s Office (OCDA) and the California Department of Insurance (CDI) announced earlier this week.

Radiologist Sim Carlisle Hoffman, MD, owner of Advanced Professional Imaging (API), Advanced Management Services (AMS), and Better Sleeping Medical Center (BSMC) in Buena Park, is charged with:

  • 592 felony counts of insurance fraud for BSMC
  • 291 felony counts of insurance fraud for API
  • One felony count of aiding and abetting the unauthorized practice of medicine

Thomas Michael Heric, MD, a neurologist who was employed by Hoffman at BSMC, stands charged with 296 counts of insurance fraud and one felony count of aiding and abetting the unauthorized practice of medicine.

Facing the same charges as Hoffman is Beverly Jane Mitchell, the administrator in charge of billing for all three of the physician’s facilities. A fourth defendant, Louis Umberto Santillan, worked for Hoffman in billing collections for API and is charged with 141 felony counts of insurance fraud.

Orange County District Attorney Tony Rackauckas told the Associated Press that Hoffman was the "mastermind of this medical mill."

Both Hoffman and Heric have previously been sanctioned for insurance improprieties.

View the OCDA's press release.http://www.insurancejournal.com/news/west/2011/06/14/202506.htm