| For Immediate Release Case # 08ZF0025
August 11, 2009 |
Susan Kang Schroeder Public Affairs Counsel Office: 714-347-8408 Cell: 714-292-2718 Farrah Emami |
CAPPER SENTENCED TO EIGHT YEARS IN PRISON FOR RECRUITING OVER 245 HEALTHY PATIENTS FOR UNNECESSARY SURGERIES IN $154 MILLION
MEDICAL INSURANCE FRAUD SCHEME
SANTA ANA – A capper was sentenced today to eight years in state prison in the largest medical fraud prosecution in the nation for recruiting over 245 healthy patients to undergo unnecessary and dangerous surgeries to fraudulently bill medical insurance companies. Olga Lilia Toscano, 41, pleaded guilty to the court to 98 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million.
The Unity Outpatient Surgery Center (Unity) scheme, in which $154 million was fraudulently billed to medical insurance companies, was a joint investigation by the California Department of Insurance and Orange County District Attorney’s Office with assistance from the California Franchise Tax Board (CFTB).
Of the 19 defendants charged in the Unity case, 13 were indicted by a criminal grand jury on June 13, 2008. The Orange County Grand Jury examined 1,054 exhibits and heard testimony from 56 witnesses over 28 days, resulting in a 70-page indictment. The indicted defendants include an attorney, accountant, three doctors, and patient recruiters known as “cappers.”
Six other defendants in the Unity case pleaded guilty prior to the indictment and have been sentenced. Including Toscano, four of the indicted defendants have pleaded guilty. The remaining nine defendants are scheduled for jury trial on Oct. 26, 2009, at the Central Justice Center in Santa Ana.
Senior Trial Counsel Todd Spitzer and Deputy District Attorney Rick Welsh of the Healthcare Insurance Fraud Unit prosecuted this case.
Case Overview
The defendants in the Unity case are accused of participating in a $154 million medical insurance fraud scheme that recruited 2,841 healthy people from all over the country to receive unnecessary surgeries in exchange for money or low cost cosmetic surgery. The recruitment of patients, or “capping,” is illegal in California. Insurance companies paid out more than $20 million during a 9-month period.
Administrators
Rosalinda Landon and Dee Francis are accused of being clinic administrators and recruiting doctors and cappers. They are accused of running the Unity facility, coordinating the fraudulent surgeries, mailing all facility billings, receiving payments from insurance companies on fraudulent billings, receiving and paying capper invoices for patient procedures. Administrators Tam Vu Pham, Huong Ngo, and Lan Nguyen, have pleaded guilty to performing the same roles in the scheme. Pham, the primary perpetrator, was sentenced to 12 years in state prison.