SAN DIEGO , Feb. 13 —Attorney General Edmund G. Brown Jr. announced Friday the arrests of two individuals who reportedly filed false claims with Medicare for services that were never performed.
“The defendants hatched a scheme to bilk Medicare out of more than a million dollars,” Brown said. “They stole the identities of people on Medicare and made claims for procedures that were never performed.”
Two of the defendants — a husband and wife — owned and operated Balboa Therapy Center in San Diego. From July 2005 to June 2006, they, along with an alleged accomplice, paid unsuspecting seniors at retirement homes $100 to obtain their insurance information and sign their names on blank medical forms.
The trio then paired the seniors’ signatures and Medicare insurance numbers with provider ID numbers from licensed physicians to submit fake claims. None of the claimed procedures were performed, and the physicians listed on the claims had no idea their names were being used to perpetrate the scheme.
Balboa Therapy Center functioned primarily as a front. Some of the staff at Balboa reported going days without seeing a single patient. The defendants hired licensed physicians as “directors” at the clinic to gain access to their Medicare provider ID number in order to submit the false claims to Medicare. The physicians were unaware that their provider ID numbers were being used to file the claims.
When some senior citizens began to receive receipts and other forms from Medicare indicating that they had been treated at Balboa Therapy Center, they contacted the California Department of Justice (DOJ). The DOJ’s Bureau of Medi-Cal Fraud and Elder Abuse began an investigation that led to criminal charges against the following defendants in San Diego Superior Court:
• Sanjay Patel, 41. Patel and his wife, Leena Patel, owned Balboa Therapy Center. They were arrested in Connecticut just before they attempted to flee the country for India.
• Leena Patel, 36.
The defendants, who are being held at Hartford County Jail in Connecticut, are being charged with thirteen criminal counts including grand theft, identity theft, health benefits fraud, receiving stolen property and money laundering. If convicted, they could face over twelve years in prison.
The Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse investigates and prosecutes those who file fraudulent claims for medical services, medical equipment and drugs.
In the 2007/2008 fiscal year, Attorney General Brown was able to recover over $161 million in government funds that had been lost due to fraud and obtained 70 convictions.
To report fraud or abuse, call the Bureau of Medi-Cal Fraud and Elder Abuse’s hotline at (800) 722-0432.