Current Health Care Fraud Related Investigations, Projects, and Litigation

Knox Ricksen LLP specializes in health care fraud, including comprehensive handling of complex and large-scale health care fraud litigation, including qui tam actions brought pursuant to the California Insurance Frauds Prevention Act (California Insurance Code, § 1871.7). Knox Ricksen LLP represents clients in cases against individuals and entities engaging in unfair and fraudulent practices such as illegal ownership of professional corporations, medical and chiropractic fraud, health care billing fraud, staged accident schemes, auto body fraud, and several other types of fraud.

Retained by individuals, major insurance carriers, and other payors providing health care benefits, including workers’ compensation, auto, and health insurers, Knox Ricksen LLP is currently engaged in a number of investigations and civil prosecutions involving a wide variety of fraudulent or suspected fraudulent activities:

  • Prosecuting a state qui tam action against an unlicensed individual and others in connection with the illegal ownership of a medical corporation in which false and fraudulent billings and reports were submitted in support of claims under auto policies
  • Investigating over 6,000 claims totaling over $95 million paid against auto policies issued by a major insurance carrier in which sham law offices operated by layperson cappers submitted fraudulent bodily injury, medical payments, car rental, and property damage claims
  • Investigating toll-free attorney referral operations in Southern California involving suspected capping, running, steering, and illegal fee splitting and kickbacks between and among unlicensed persons, attorneys, body shop owners, and health care providers
  • Investigating illegal ownership of radiology and surgery centers, illegal kickbacks, and fee-splitting on behalf of an individual whistleblower
  •  Prosecuting a state qui tam action against a group of individuals operating auto glass companies that installed  after-market auto glass and submitted bills for original manufacturer auto glass  to an auto insurance carrier
  • Prosecuting a state qui tam action against laypersons, diagnostic centers, surgery centers, attorneys, chiropractors, and medical doctors on behalf of a major auto insurance carrier involving percutaneous disc decompression surgeries, illegal ownership of medical corporations and diagnostic facilities, falsified medical records, false billings, and the use of a fraudulent factoring company
  • Investigating medical doctors for illegal dispensation of pharmaceuticals for financial gain including compound medication and packages of medication on behalf of a major insurance carrier
  • Prosecuting a state qui tam action against chiropractors and medical doctors for operating sham medical corporations and illegally dispensing prescription medication, including narcotic medication and other controlled substances, through the use of traveling per diem medical doctors at chiropractic offices
  • Prosecuting lien consolidations on behalf of a major workers’ compensation carrier involving companies that purport to be “factoring” companies who purchases accounts receivable from health care providers that prescribe compound pharmaceutical drugs but instead act as “dealers” or “brokers” of a pre-arranged compound pharmaceutical drug prescription scheme all for the purposes of profit
  • Prosecuting lien consolidation on behalf of a major workers’ compensation carrier involving illegal ownership of a medical corporation by a chiropractor, illegal fee-splitting, and the preparation and submission of fraudulent bills for psychological services not rendered
  • Prosecuting lien consolidation on behalf of a major workers’ compensation carrier involving illegal fee splitting, preparation and submission of fraudulent bills for orthopedic services not rendered, and non-FDA approved pharmaceutical cream medication
  • Investigating liens on behalf of major workers’ compensation carrier involving illegal ownership of a sleep diagnostic corporation by laypersons and preparation and submission of fraudulent bills and reports for neurological sleep studies
  • Investigating workers’ compensation claims and medical liens for major workers’ compensation carrier involving sham ownership of law firm, illegal fee-splitting, illegal referrals, illegal self referrals, payment of kickbacks, services not rendered, and services rendered by unlicensed individuals
  • Securing a $7.7 million state qui tam judgment in Mach 2013 against the unlicensed lay-owners of an illegal chiropractic corporation and health care management corporation who submitted more than 390 claims to a major insurance carrier that were falsely generated by unlicensed and untrained persons which included the recruitment and steering of patients, setting standard operating procedures for patient treatment regardless of medical need, and submitting false narrative reports and bills
  • Investigating a medical doctor and chiropractor on behalf of a major insurance carrier involving the illegal providing of physical therapy in a soft-tissue injury mill operation
  • Prosecuting a state qui tam action against the unlicensed lay-owner of a medical corporation, a sham physician owner and health care providers to which patients were illegally steered and involving the submission of false and deceptive narrative reports and billing statements, illegal ownership of a medical corporation and illegal fee-splitting and kick-backs
  • Collecting on a $7 million qui tam judgment against California chiropractor Daniel H. Dahan, involving the illegal ownership of a radiology practice, the production of false radiology reports and the submission of false billing statements and reports to Allstate Insurance Company in support of 487 claims
  • Investigating the manufacturers and distributors of spinal implants, hospitals, physicians, diagnostic facilities and referring chiropractors and physicians relative to the production, distribution and use of counterfeit pedicle screws, rods, cages and spacers used in approximately 4,000 surgeries throughout the U.S. on behalf of public payors, insurance carriers and individuals
  • Investigating the distribution and billing practices of the distributor of durable medical equipment on behalf of a major workers’ compensation carrier
  • Prosecuting a state qui tam action against a health care management corporation, the chiropractor-owner and sham physician owner of an illegal medical corporation involving the submission of false and deceptive narrative reports and bills, treatment rendered by unlicensed individuals and rendering unnecessary and illegal chiropractic and medical treatment in support of claims against a major auto insurer