Chiropractors, physicians busted for fraud schemes in New Jersey
Two separate criminal indictments resulted in the arrest of eight New Jersey providers, three of whom are chiropractors, for allegedly participating in fraud schemes that illegally siphoned patient referrals to other practitioners and a diagnostic imaging company.
One scheme, which ran through the office of Kenneth Gross, a chiropractor in Passaic, involved patient referrals to practitioners in other counties with close ties to Gross, according to NorthJersey.com. His wife, Michele Dubnoff, was one of the physicians implicated in the scheme, along with James Morales, an orthopedist with financial ties to Gross.
After a nine-month investigation, prosecutors are not yet sure of the extent of the scheme, but cited specific examples in which Gross billed $18,000 for services that were never provided. Undercover agents reportedly went to Gross's office last year and witnessed him coaching patients to rewrite police reports and reporting certain injuries to insurance companies before referring them to Morales, the article said.
Elsewhere in the state, four physicians and a chiropractor were indicted for accepting cash bribes from Rehan Zuberi, who previously pled guilty to orchestrating an $8 million Medicaid scheme through his company Diagnostic Imaging Affiliates (DIA), according to a statement from the New Jersey Office of the Attorney General.
Zuberi paid the physicians arrested for their involvement with the scheme as much as $6,000 to $7,000 per month. Various specialists--including an internist, an oncologist, a gynecologist/obstetrician, a family practitioner and a chiropractor--sent thousands of scans to DIA between 2006 and 2013, receiving hundreds of thousands in kickbacks in return.
Earlier this year, a string of cases in Texas, New Orleans, and Philadelphia highlighted the risks of chiropractic fraud. These cases often involve excessive billing and upcoding, Dan Bowerman, principal at Expert Opinions Consulting in Philadelphia, said in an exclusive interview with FierceHealthPayer: AntiFraud.
New Jersey was the site of another massive diagnostic imaging fraud case involving Biodiagnostic Laboratory Services Inc., which ran a 37-person, $200 million kickback scheme.
Couple pleads guilty to kickback scheme involving 10 imaging centers
Pulling back the curtain on a $200 million fraud scheme
String of cases highlights prevalence of chiropractic fraud
What payers should know about chiropractic fraud, waste and abuse