A jury in Riverside County returned a guilty verdict on charges of insurance fraud and perjury against an 86-year-old doctor on Oct. 4. He could potentially receive 18 years in a state correctional facility. After paying $30,000 in bail, the doctor secured his release while awaiting his sentencing hearing.
According to evidence presented at his trial, he had committed fraud on workers' compensation cases by billing for medical-legal reports. Doctors prepare these reports for disputed work injury cases. He sent bills to multiple employers within the state for reports on disputes that did not exist. The district attorney's office reported that he had billed companies for $90,000 to write reports that no one requested.
The state requires qualified medical evaluators to prepare these reports. Although the doctor had been a QME in the past, the Department of Industrial Relations reported that he had lost that certification prior to sending out his fraudulent reports. By continuing to represent himself as a QME, he was convicted of perjury.
The doctor had a history of misconduct. In 2013, the California Medical Board placed him on probation for improper handling of multiple cases. In February, the board suspended his license after the emergence of criminal charges against him.
Cases that involve insurance law often benefit from the attention of a lawyer familiar with insurance contracts and regulatory requirements. A person or organization with questions about potentially fraudulent activity or breaches of contract could discuss the issues with an attorney. Legal counsel might identify specific evidence of wrongdoing and manage the response. Depending on the situation, an attorney might negotiate a settlement with an opposing party or pursue a civil or criminal complaint.