RADIOLOGIST, NEUROLOGIST, AND TWO CO-DEFENDANTS INDICTED IN $17 MILLION WORKERS’ COMPENSATION INSURANCE OVERBILLING SCHEME

Orange County District Attorney
Press Release


Tony Rackauckas, District Attorney
401 Civic Center Drive West
Santa Ana, CA 92701

For Immediate Release
Case # 11ZF0110

 




June 13, 2011

Susan Kang Schroeder
Chief of Staff
Office: 714-347-8408
Cell: 714-292-2718

Farrah Emami
Spokesperson
Office: 714-347-8405
Cell: 714-323-4486

RADIOLOGIST, NEUROLOGIST, AND TWO CO-DEFENDANTS INDICTED IN $17 MILLION WORKERS’ COMPENSATION INSURANCE OVERBILLING SCHEME

*Grand jury transcripts revealed for the first time

 

SANTA ANA – The Orange County District Attorney’s Office (OCDA) and California Department of Insurance (CDI) announced today the facts surrounding the indictment of a radiologist, a neurologist, and two co-defendants for a $17 million workers’ compensation insurance overbilling scheme. The indictments against the four defendants were issued May 11, 2011, and the grand jury transcripts were unsealed today, June 13, 2011. 

 

We need to end these types of medical fraud mills – STAT. Let’s end unethical doctors, unscrupulous dealings, and patients being treated like walking ATMs,” stated District Attorney Tony Rackauckas. “We hope before people engage in these types of schemes, they ask themselves if this is worth 800 years in prison?”

 

“The magnitude of the fraud committed by these co-conspirators is reprehensible,” said Insurance Commissioner Dave Jones. “When medical providers conspire to defraud the California workers’ compensation insurance system, everybody loses, including the injured workers and the businesses that employ them.”

 

This case was investigated by CDI and the OCDA. Deputy District Attorney Shaddi Kamiabipour of the Workers’ Compensation Fraud Unit is prosecuting this case.

 

Defendants

Dr. Sim Carlisle Hoffman, 59, Newport Beach, is a radiologist and owner of Advanced Professional Imaging (API), Advanced Management Services (AMS), and Better Sleeping Medical Center (BSMC) in Buena Park. He is charged with 592 felony counts of insurance fraud for BSMC, 291 felony counts of insurance fraud for API, and one felony count of aiding and abetting the unauthorized practice of medicine. If convicted, he faces a sentence ranging from two years up to 892 years and eight months in state prison. Hoffman is out of custody on $1.5 million bail. In 2001, Hoffman was disciplined by the Medical Board of California (Board) for excessive billing and subjecting a patient to radiology procedures that were not medically necessary. 

 

Beverly Jane Mitchell, 60, Westlake Village, is the administrator in charge of insurance billing for all of Hoffman’s businesses. She faces the same charges and maximum sentence as Hoffman. Mitchell is out of custody on $250,000 bail.

 

Dr. Thomas Michael Heric, 74, Malibu, is a neurologist who worked for Hoffman at BSMC. He is charged with 296 counts of insurance fraud and one felony count of aiding and abetting the unauthorized practice of medicine. If convicted, he faces a sentence ranging from two years up to 315 years and eight months in state prison. Heric is out of custody on $500,000 bail. His medical license was suspended by the Board for 60 days as a result of a 2008 felony federal Medicare and Medi-Cal fraud conviction.