Chiropractor Admits Role in Insurance Fraud Scheme
|U.S. Attorney’s Office December 07, 2011|
David B. Fein, United States Attorney for the District of Connecticut, announced that MARC KIRSHNER, D.C., 46, of Stamford, waived his right to indictment and pleaded guilty today before United States District Judge Stefan R. Underhill in Bridgeport to one count of conspiring to commit mail fraud to defraud insurance carriers of nearly $1.7 million.
According to court documents and statements made in court, KIRSHNER has owned and operated two chiropractor offices in Bridgeport and one in Stamford, each employing between one and four chiropractors. The chiropractor offices in Bridgeport, called Health First Medical PC (“Health First”), are no longer operating.
From approximately December 2006 to February 2010, KIRSHNER conspired with a personal injury attorney and others to defraud various insurance carriers by submitting information to the victim carriers for the settlement of the attorney’s accident cases that exaggerated the severity of patient injury and the cost of medical care in order to receive larger settlement payments. In pleading guilty, KIRSHNER also admitted that he permitted the attorney to influence improperly the course of patients’ medical treatment by acquiescing to the attorney’s instructions that patients receive certain treatments and diagnostic tests, despite the questionable medical need for the treatments and tests.
As part of the conspiracy, KIRSHNER met with the attorney numerous times to provide him with cash in exchange for checks made out to KIRSHNER, knowing that the attorney could use the cash for, among other things, paying individuals to find potential victims of auto accidents for the attorney to represent. During the course of the conspiracy, these cash payments total as much as $100,000. KIRSHNER allowed the attorney to establish what Health First would be paid for services rendered, which allowed the attorney to misrepresent and inflate the size of medical bills tendered to the victim insurance carriers for payment.
KIRSHNER and Health First established a protocol to treat patients in the attorney’s cases for six months, regardless of medical need, and would not resolve treatment of patients unless instructed to do so by the attorney. After the six-month period, each patient would receive a permanent partial disability rating, regardless of the permanence of the medical condition. If a patient had received a permanency rating for a prior accident, the protocol was to give a higher or different disability rating for the present accident.
KIRSHNER also admitted that he knew that the attorney was using Francisco Carbone as a treating physician for clients, even though he knew that Carbone had lost his medical license. KIRSHNER never challenged the attorney’s continued use of Carbone, or questioned Carbone’s role in the obtaining for those clients prescriptions for unduly strong pain medication, including hydrocodone, Vicodin, and Percocet.
KIRSHNER also owned a diagnostic testing company, Midas Medical LLC, and instructed his employees to conduct Nerve Conduction Velocity Tests whenever a patient’s symptoms could potentially implicate testing, even though he knew the test results would not change the course of treatment. KIRSHNER also arranged for Carbone to order the tests, believing that, if ordered by a doctor, the tests would be given greater weight by the victim insurance companies and increase the likelihood of higher settlement payments.
As a result of his role in this conspiracy, more than 10 insurance carriers lost a total of approximately $1.69 million.
This matter stems from “Operation Running Man,” a 14-month undercover operation headed by the Federal Bureau of Investigation. The investigation included the use of recordings of an undercover special agent meeting with the attorney, various doctors and chiropractors as part of a staged auto accident personal injury case.
When he is sentenced, KIRSHNER faces a maximum term of imprisonment of five years and a fine of up to approximately $3.4 million.
On July 19, 2011, Francisco Carbone pleaded guilty to one count of conspiring to commit mail fraud to defraud insurance carriers, one count of conspiring to commit mail fraud to defraud the State of Connecticut, one count of making a false statement relating to health care matters, and one count of conspiring to distribute controlled substances outside the scope of the usual course of professional practice. He awaits sentencing.
U.S. Attorney Fein stated that the investigation is ongoing.
This case is being investigated by the Federal Bureau of Investigation, with the assistance of the National Insurance Crime Bureau and Metropolitan Property and Casualty Insurance’s Special Investigation Unit. The case is being prosecuted by Assistant United States Attorneys Christopher W. Schmeisser and Susan Wines.