Guilty Pleas in Massive Medical Billing Fraud Case

As featured in the February 2019 edition of ICW Group’s Monthly Anti-Fraud Newsletter, ICW Group’s Special Investigations Unit (SIU) played a key role in uncovering a massive medical billing fraud scheme. The scheme involves attempting to defraud the California Workers’ Compensation system of at least $123 million by billing for high dollar medications; medication which the patients are suspected to rarely, if ever, have received.

Riverside County District Attorney’s Office, in conjunction with San Bernardino County District Attorney’s Office has now secured guilty pleas from three of the co-conspirators, with cooperative testimony now pointing to two other key defendants as primary operators of the enterprise. In addition, a second enterprise which the co-conspirators attempted to stand up after the initial enterprise was shut down by law enforcement. It was confirmed that they were part of the scheme, a development that may make their billings unrecoverable by state regulations.

ICW Group SIU will continue to cooperate with law enforcement as this prosecution proceeds.