| For Immediate Release Case # 08ZF0025
August 10, 2009 |
Susan Kang Schroeder Public Affairs Counsel Office: 714-347-8408 Cell: 714-292-2718 Farrah Emami |
CAPPER WHO RECRUITED HEALTHY PATIENTS FOR UNNECESSARY SURGERIES SENTENCED TO EIGHT YEARS IN PRISON FOR$154 MILLION MEDICAL INSURANCE FRAUD SCHEME
SANTA ANA – A capper who pleaded guilty on Friday to plead guilty in the largest medical fraud prosecution in the nation was sentenced to eight years in state prison for recruiting over 90 healthy patients to undergo unnecessary and dangerous surgeries to fraudulently bill medical insurance companies. Maria DeJesus Licea Rosales, 42, Orange, was convicted of 96 felony counts including conspiracy, capping, insurance fraud, grand theft, filing fraudulent tax returns, and sentencing enhancements for white collar crime and loss over $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.”
Capper Sue Nanda, 41, Costa Mesa, pleaded guilty Feb. 20, 2009, to 22 felony counts including conspiracy, capping, failing to file tax returns, filing fraudulent tax returns, grand theft, and sentencing enhancements for white collar crime. She was also sentenced Friday, Aug. 7. 2009, and received 10 years in state prison.
Doctor William Wilson Hampton, Jr., 53, Seal Beach, was the second indicted defendant to plead guilty. He pleaded guilty to 47 felony counts including conspiracy, insurance fraud, and capping on May 8, 2009, and was sentenced to 16 years in state prison.
The other six defendants in the Unity case pleaded guilty prior to the indictment and have been sentenced. The remaining 11 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.