Bradley Mattson of Lake Forest, Neelesh Patel of Glenview and Steven Paul of Northbrook are on the line for defrauding private health insurance companies out of millions of dollars, according to an indictment announced earlier this week.
Mattson, 49, was charged with 19 counts of health care fraud.
The men are among 91 defendants charged across the country for submitting $295 million in false billing to Medicare and private insurance companies. Patel, Paul and Mattson owned suburban clinics that provided chiropractic, medical and physical therapy services, and now face a 23-count indictment, officials said.
If convicted, the men could face up to 10 years in prison and a $250,000 maximum fine for the health care fraud.
The partners owned and operated Hawthorn Physical medicine in Vernon Hills, Woodfield Physical Medicine in Schaumburg, Stratford Physical Medicine in Bloomingdale and Algonquin Physical Medicine in Lake in the Hills, investigators said. Mattson and Paul also owned and operated Northshore Physical Medicine in Niles and Cumberland Physical Medicine in Norridge.
“According to the indictment, the defendants submitted false insurance claims to Blue Cross and Blue Shield of Illinois, Aetna and Humana for services that either were not medically necessary or that they did not provide to patients, including X-rays, MRIs, neurological diagnostic testing, and physical therapy services,” Justice Department officials said Wednesday afternoon.
Between 1999 and 2008, the defendants allegedly billed Blue Cross more than $18 million alone, although the indictment is not clear on how much of this is alleged to have been obtained fraudulently.
Allegedly, the defendants marketed the clinics through their company, ARC Health, at malls and employee health fairs, targeting individuals’ insured by specific companies, the indictment said. According to court documents, the men told marketing employees to offer discounts and coupons that falsely advertised a free X-ray exam and a discounted office visit. The cost later was billed to the patients’ insurance companies, the indictment alleges.
Additionally, the defendants reportedly instructed their clinics’ chiropractors to order neurological diagnostic testing and MRIs for patients, whether or not they were needed, and then asked them to falsify the patients’ diagnoses so the patient’s insurance company would cover further visits and treatment.
The fraud case was investigated by the FBI and the Labor Department. Assistant U.S. Attorney Renai Rodney will be prosecuting.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team, go to: http://www.stopmedicarefraud.gov.