False workers’ compensation claims were allegedly part of a huge fraud conspiracy, according to Dr. Sana U Khan MD, and other people. Come on, let’s dig more into the Dr. Sana U Khan MD fraud case.
Sana U Khan MD: State Said that Physicians Operated “Patient Mills”
According to the state’s lawsuit in federal court, two doctors and a large number of their “patient mills” defrauded California out of millions of dollars by filing false workers’ compensation claims.
The alleged scheme’s architects, Drs. Sana U Khan MD and Alexander Zaks, as well as more than 15 clinics, imaging centers, and other offices, as well as three other individuals, were all sued by the State Compensation Insurance Fund.
The primary supplier of workers’ compensation insurance in the state is the State Compensation Insurance Fund. It charges the defendants with running “patient mills” to submit false claims and racketeering.
The state asserts that the defendants filed inflated invoices, claimed payment from the state fund for assets that the defendants did not own, and billed it for treatments that were either not provided or medically unnecessary.
The State Compensation Insurance Fund and Bruce McIntyre Roth, a former attorney for the fund who is accused of aiding Zaks’ clinics in obtaining a fictitious settlement, are defendants. The Accident Help Line Medical Group is also a defendant.
The state alleges that Sana U Khan MD and Zaks submitted fraudulent State Fund submissions and cross-referred patients to their clinics.
From 2002 to 2006, the defendants are accused by the state of submitting thousands of deceptive requests for needless diagnostic tests, such as MRIs and X-rays.
According to the complaint, the clinics prescribed unnecessary rehabilitation procedures and pain injections while billing for deep massages they did not actually provide.
According to the state, bonuses were given to staff members of the defendant clinics “based on the volume of tests and treatments ordered for their patients.”
According to the complaint, the California Department of Insurance looked into Accident Help Line Medical Group clinics by sending undercover workers’ compensation “patients” who “complained of little or no pain or discomfort” but still received treatment – even if their medical providers denied authorization.”
As an internal attorney in the Special Litigation Unit of the State Funds, the state claims that Roth joined the scheme in the summer of 2009.
The complaint asserts that while serving in that capacity, Roth was in charge of looking into bogus claims and defending State Fund in court proceedings before the WCAB [Workers’ Compensation Appeals Board].
In 2005, Roth was tasked with looking into Zaks’ medical clinics in Los Angeles County. According to the lawsuit, Roth discovered evidence of fraud, including a State Fund payment of roughly $2.4 million for fictitious translation services.
According to the complaint, Roth negotiated a settlement that was unfavorable to the State Fund even though his role in the legal dispute with Zak’s clinics was to represent the State Fund’s interest. Those entities were requesting more than $10 million based on suspected fraudulent billings.
According to the complaint, “Beginning around July 2009, acting with intent to defraud State Fund and to further the fraudulent scheme, Roth covertly created an agreement to settle with the Zaks entities, obligating State Fund to pay between 100% and 1400% of the value of such claims and including interest and penalties (the “fraudulent settlement”).
As Roth was aware, State Fund frequently paid a small portion of the billed amount and hardly ever paid interest or penalties in past settlement agreements of a similar nature.
In doing so, Roth took deliberate actions to try to hide the unapproved settlement agreement from State Fund and did so with knowledge and without State Fund’s knowledge or approval.
In order to defend Zaks and Khan, the state asserts that Roth participated in the fund’s deception and carried out the settlement.
According to the lawsuit, at the beginning of 2010, when Roth was still employed by the State Fund, he was chosen to serve as legal counsel for Global Holdings, whose chief medical officer is Sana U Khan MD.
The state alleges that Sana U Khan MD-owned clinics filed false lawsuits against the fund, accusing it of racketeering by refusing to release medical liens totaling $20 million. The state claims that this lawsuit was dismissed this year for failing to articulate a claim.
A no-fault system governs workers’ compensation insurance. For workers’ compensation benefits for an on-the-job accident, injured employees do not have to show that the injury was someone else’s responsibility. Some wounded workers are eligible to receive a portion of their lost wages as compensation for their injuries, in addition to having their medical bills paid for. Criminals may find it alluring to seek fraudulent workers’ compensation claims.
“Each of the claims linked to the Sana U Khan MD Lawsuit was illegally charged at sums substantially over the OMFS (Official Medical Fee Schedule), for treatments that were either not provided or were medically unnecessary,” the complaint claims.
For fraud and RICO conspiracy, the state asks for treble damages as well as punitive damages.
Requests for feedback from Roth and Sana U Khan MD did not immediately receive a response.
Sana U Khan MD: Case Background
What is State Fund?
California’s government created the State Fund, a non-profit public enterprise fund, in accordance with California Insurance.
Employers are given workers’ compensation insurance coverage under which ill and injured workers can get medical care as well as indemnity benefits. Medical providers are paid by the State Fund for services they deliver to covered employees.
Medical providers must send State Fund health insurance claim forms via mail or electronically over interstate lines in order to be reimbursed for their services.
According to State Fund, the Khan Defendants, the Zaks Defendants, and the Defendant Bruce Roth participated in a plot to defraud State Fund.
In accordance with the Second Amended Complaint (“SAC”), the plan got started around 2000 when Mr. Zaks and Mr. Sana U Khan MD decided to cross-refer patients to their respective clinics, the Zaks Entities and Sana U Khan MD Entities, in order to produce false claims for payment from State Fund.
Mr. Holmes and Mr. Reyes were purportedly employed by Mr. Zaks and Mr.Sana U Khan MD to manage the day-to-day operations of the fraudulent enterprise. As part of the scam, Defendants would ostensibly ask the State Fund for payment for procedures that weren’t carried out, weren’t essential, or were upcoded. Defendants allegedly sent the fake bills to State Fund via wire transfers and US mail.
The difference between the amount demanded and the amount paid would be the subject of a lien filed by the defendants with the Workers’ Compensation Appeals Board (“WCAB”) if the State Fund denied any portion of the claims.
In order to enforce the liens, according to State Fund, Defendants allegedly entered into false settlement agreements for claims that were being heard by the WCAB.
What is State Compensation Insurance Fund?
Employers in California can obtain workers’ compensation insurance from the State Compensation Insurance Fund (State Fund), a self-supporting, nonprofit organization. In the first place, it will cover all claims for medical costs and benefits related to compensation.
The State Fund would bill all legally uninsured agencies and departments (i.e., any agencies and departments not covered by workers’ compensation insurance policies) for the benefits paid in addition to a fee for the administration provided by the State Fund.
Under a general agreement signed by the State Fund and the California Department of Human Resources (CalHR), the latter fees are permitted for all validly uninsured agencies and departments.
The monies from which the injured or killed employee’s salary or wages were due at the time of the injury or death are used to cover these bills by lawfully uninsured departments and/or agencies.
When referring to agencies or departments that are subject to financial adjustment plans, “fund or funds” refers to the fund or funds that, after financial adjustment, were finally used to pay the employee’s salary or wages.
AUDIT AND PAYMENT
On the 15th and the 30th or 31st of each month, the State Fund will send agencies and departments a bill. On the State Fund Form e3067, agencies, and departments must use the appropriate agency payroll code.
The agency payment code will also be included on the bills delivered to the departments or agencies. This code will make it easier to allocate the Workers’ Compensation costs to the various divisions of the agency or department as necessary.
Conclusion
Last but not least, the State of California recently filed a complaint accusing Drs. Sana U Khan MD and Alexander Zaks, as well as a number of medical facilities and people, charged them with running “patient mills” and making false workers’ compensation claims.
The defendants are accused of submitting exaggerated invoices, demanding compensation for assets they did not own, and billing for services that were not rendered or that were medically unnecessary, according to the state.
Bruce McIntyre Roth, a former State Compensation Insurance Fund attorney, is also charged with participating in the fraudulent scheme. For fraud and RICO conspiracy, the state asks for treble damages as well as punitive damages. The accusations have not yet received a response from Roth or Sana U Khan MD.
What do you think about Dr. Sana U. Khan’s harsh behavior?? Well, you can follow the link mentioned below to know more about the case of Dr. Sana U Khan MD:
God Damn’ Why I’m not aware of these types of bluffs?!?!..
This is sad that doctors like Sana U Khan make false claims for their benefit.
But, why is he doing this? And who permitted him to engage in these illicit activities?
Such an informative stuff.
The involvement of the attorney in the fake scheme shows the extent of medical fraud.
What a doctor. He belongs behind bars!
I believe we need some strong enforcement and harsher punishment to stop these types of medical frauds.
Being an MD and committing these types of fraud is not acceptable in society.