Two Chiropractors Involved in Insurance Fraud Schemes are Sentenced
Deirdre M. Daly, United States Attorney for the District of Connecticut, announced that two chiropractors convicted of charges stemming from an investigation into health care and insurance fraud were sentenced today by U.S. District Judge Stefan R. Underhill in Bridgeport. JENNIFER LYNNE, 41, of Milford, was sentenced to three years of probation, the first six months of which she must serve in home confinement with electronic monitoring. GEORGE U. DeCARVALHO, 57, of Stamford, was sentenced to three years of probation, during which he must perform 90 hours of community service.
This matter stems from “Operation Running Man,” a 14-month undercover fraud investigation headed by the Federal Bureau of Investigation. The investigation, which included the use of recordings by an undercover FBI special agent, revealed that Joseph P. Haddad, a Bridgeport-based personal injury attorney, conspired with chiropractors and others to defraud several insurance companies by exaggerating the auto accident injuries of Haddad’s clients, and the cost of their medical care, to justify larger monetary settlements with the insurance companies. As part of the scheme, the co-conspirators fabricated medical records, prescribed unnecessary pain medication, performed unnecessary chiropractic treatment, ordered and billed for diagnostic tests of questionable medical value, and overstated injuries or permanent partial disabilities that were allegedly caused by the accidents.
Between December 2006 and February 2010, Haddad conspired in the scheme with Francisco R. Carbone, who had been licensed to practice medicine until his license was revoked by the State of Connecticut in March 2005, and with Dr. Marc Kirshner, who owned and operated two chiropractor offices in Bridgeport and one in Stamford.
As part of the scheme, Haddad paid “runners” to locate and deliver to him clients for his personal injury practice. Haddad then regularly instructed clients to see Carbone for purported medical treatment, even though Haddad was aware that Carbone had lost his medical license. Carbone provided Haddad’s clients with prescription pain medication, even if the medication was not needed and, in reports, fabricated the clients’ injuries, medical conditions and permanent partial disability ratings. In multiple instances, Carbone did no medical examination at all. Carbone billed the victim insurance carriers in his name or in the name of another physician for services he allegedly rendered, and provided prescriptions, bills, medical reports and final reports to Haddad, who submitted the documents to the victim carriers to support requests for settlement.
Haddad also referred clients to Dr. Kirshner’s Bridgeport chiropractor offices, which operated under the name Health First Medical, P.C. Kirshner often permitted Haddad to influence the course of patients’ medical treatments by acquiescing to Haddad’s instructions that a patient receive more treatment and diagnostic tests despite the questionable need for both.
LYNNE and Jennifer Netter are licensed chiropractors who worked for Kirshner. Between approximately December 2006 and February 2010, Health First chiropractors performed unnecessary chiropractic treatments on Haddad’s auto-accident clients. As part of the scheme, the chiropractors established a protocol to treat patients in Haddad’s cases for six months, regardless of medical need, and would not resolve treatment of patients unless instructed to do so by Haddad. The chiropractors often falsified medical records by indicating that they had examined the patients when they had not, and by misrepresenting that patients’ pain complaints and other symptoms continued. 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. The chiropractic practice prepared false reports, which were then provided to the victim insurance carriers.
More than 10 insurance carriers lost at least $1.7 million as a result of this fraud scheme. The loss directly attributable to LYNNE’s dealing with Haddad clients is $117,251. Judge Underhill today ordered LYNNE to pay restitution in that amount.
On March 15, 2012, LYNNE pleaded guilty to one count of conspiracy to make false statements relating to health care matters.
DeCARVALHO is a licensed chiropractor who owns and operates a chiropractic practice in Bridgeport. DeCARVALHO and Carbone shared office space in Bridgeport from approximately January 2004 to November 2005. Before Carbone’s medical license was revoked, DeCARVALHO and Carbone provided chiropractic and medical treatment on a number of common patients who were involved in auto-accident litigation. After March 2005, DeCARVALHO continued to treat certain patients knowing that payments for his services were coming from insurance settlements based, in part, on the purported treatment provided by Carbone.
In addition, in May 2007, DeCARVALHO was involved in an auto accident in which the other driver was liable. DeCARVALHO contacted Carbone to fabricate medical records to show that DeCARVALHO had suffered certain injuries and had received medical treatment for those injuries allegedly sustained from the accident. DeCARVALHO indicated that Carbone could bill carriers for treatment under DeCARVALHO’s automobile MedPay insurance. In October 2007, Carbone fabricated the medical records and submitted claims to MedPay for reimbursement totaling approximately $6,000. Relying on the false medical bills, DeCARVALHO subsequently settled the accident claim for an additional $4,500.
On June 29, 2012, DeCARVALHO pleaded guilty to one count of conspiracy to commit health care fraud.
Haddad, Carbone, Kirshner, Netter, and Dr. James Marshall, Jr. have each pleaded guilty to charges stemming from this scheme. They await sentencing.
This matter has been investigated by the Federal Bureau of Investigation, with the assistance of the National Insurance Crime Bureau, the Metropolitan Property and Casualty Insurance’s Special Investigation Unit and the Travelers Insurance Company.
The case is being prosecuted by Assistant U.S. Attorneys Christopher W. Schmeisser and David J. Sheldon.