TWO CHIROPRACTORS AND A CLINIC DIRECTOR ARRESTED AND INDICTED FOR WORKERS’ COMP INSURANCE FRAUD

OCDASeal

Orange County District Attorney
Press Release


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

For Immediate Release
December 11th, 2003
Contact:Mark Macaulay
Media Relations Director
(714) 347-8405

SANTA ANA – The Orange County District Attorney’s Office announces the arrest and indictments of two Santa Ana chiropractors and a clinic director for committing workers’ compensation insurance fraud.  An 8-month undercover investigation by the Department of Insurance named “Operation Capper” revealed that these individuals were filing fraudulent insurance claims and illegally paying compensation for referral of clients.  The indictments were unsealed this morning in the Orange County Superior Court.  Deputy District Attorney Rick Welsh who presented the case to the Grand Jury is the assigned prosecutor.

Chiropractors Franco Wilfredo Gamboa, 46, of Diamond Bar, and Edgar Eduardo Esparza, 28, of Downey, were indicted on 12 felony counts.  The chiropractors were charged with two counts of filing fraudulent workers’ compensation insurance claims, six counts of presenting false information on an insurance claim, four counts of illegally paying money for patient referrals.  Gamboa and Esparza are accused of illegally paying cash for workers’ compensation referrals to undercover investigators posing as patients and then billing the company’s insurance provider for treatments that were unnecessary.  If convicted, the chiropractors face 7 years and 4 months in state prison and/or $200,000 in fines. 

South Gate Medical Clinic director Hilda Ramona Fernandez, 61, of La Canada, was indicted after a separate 6-month investigation by the Department of Insurance on three felony counts of insurance fraud and one felony count of receiving money for patient referrals. Fernandez is accused of illegally paying cash for workers’ compensation referrals and falsely billing for medical services that were not rendered to three undercover officers, who had portrayed themselves as soon to be laid-off employees.  If convicted, Fernandez faces up to seven years and eight months in state prison and/or $160,000 in fines. 

“Workers’ compensation insurance fraud hurts everyone, whether you are a business owner, taxpayer, job seeker, or someone who is legitimately hurt and needs the funds,” stated Orange County District Attorney Tony Rackauckas.  “Let this be a warning to anyone looking to make a quick buck at the expense of our economy and the jobs of hard working individuals.  We are on to you, you will be caught, and I can assure you it won’t be worth it.”