News Main Page
Email A Friend
July 29, 2015
Zurich Considering Buying RSA Insurance Group
July 27, 2015
Anthem Finally Gets Cigna To Agree To Purchase For $54 Billion
July 23, 2015
Report on Workers’ Comp Reforms Shows Benefit Increases for Injured Workers, Reduced Costs to Employers
July 21, 2015
No Responses Yet On How ACE - Chubb Merger May Affect Claims Department In California
|Search Warrant Served Against Aspen Medical Resources In Anaheim Reveals Double Billing Was Consistently Done For Renting Hundreds Of ThermoCool Hot-Cold Units|
By Lonce LaMon - September 18, 2012
On August 15th 2012, a raid was conducted by the Orange County District Attorney’s office against a Durable Medical Equipment Company called Aspen Medical Resources. Aspen Medical is located in Anaheim, California, within a commercial complex at 685 North Shepard Street.
The Search Warrant was issued on August 13th 2012 and was signed and authorized by Judge Walter Schwarm. The Deputy District Attorney prosecuting this case is Shaddi Kamiabipour. The violations charged by the Orange County DA are:
CPC 487 for Grand Theft, which is when the money, labor, real or personal property is for more than $950.00.
CPC 550 (a) (5) for Making False Fraudulent Claims, when one does or aids, abets, solicits, or conspires with any person to knowingly prepare, make, or subscribe any writing, with the intent to present or use it or allow it to be presented, in support of any false or fraudulent claim.
CPC 550 (a) (6) is exactly the same as above except that it adds: for payment of a healthcare benefit.
This case was initiated by Jennifer Conner, a senior investigator from American Claims Management (ACM) in San Diego, California, and sent to the California Department of Insurance in December of 2010. By June 16th 2011, the Orange County District Attorney’s office had received the Suspected Fraud Claim submitted by Conner via the Department of Insurance.
American Claims Management, representing the alleged victim, Manufactures Alliance Insurance Company, indicated that Aspen Medical Resources billed for durable medical equipment using incorrect billing codes to obtain higher reimbursement than is warranted. Jennifer Conner interviewed a former employee of Aspen Medical who
said in a phone statement that she believed that durable medical equipment was being billed purposely incorrectly in order to receive higher reimbursement.
It suggests that he (Jeff Campu) had exploitive psychological intentions because without even being accused of anything, he "lawyered-up".
In January of 2012, the investigator from the Orange County DA’s office, Louis Martinez III, met with an investigator named Danelle McPeak from First Comp Insurance Company. McPeak had emailed Martinez a Craigslist notice for the purchase of an Aspen Medical Resources ThermoCool Unit. The seller was a former claimant who had had a work injury.
This former claimant, Dameon Patrick Butler, met Danelle McPeak at a Jack-In-The-Box in Corona, California in order to sell her the ThermoCool for $250.00. Dameon Butler told Danelle McPeak that he had never used the ThermoCool Unit. Thus, Danelle paid him $250.00 for the ThermoCool and then delivered it to DA investigator Louie Martinez III.
A letter from The Travelers Insurance Company, written by Steven B. McCoy, Medical Investigator from the Diamond Bar claims center, dated April 19th 2011, politely speaks to one of the owners of Aspen Medical Resources, Jeff Campu. The other owner of Aspen Medical, Landen Mirallegro, was not addressed in the letter.
Steven McCoy writes to Jeff Campu, “We consider the billing presented by your company to be lacking complete and supporting documentation…” He goes on to explain very matter-of-factly that Aspen has presented numerous invoices for a Hot Water Circulation Hot Pad with Pump and a Cold Water Circulation Pad with Pump on the same dates of service, and that they have interviewed injured workers and determined only a single pad and pump were provided. While acknowledging that some of the units provide both hot and cold circulating water, they are nevertheless a single device.
McCoy further explains very cordially that the billing looks like two separate devices were issued. Th
e adjusters relied on the information when issuing payments. He had a certified coder review the bill, and the coder gave the opinion that the bills may have been coded incorrectly.
Steven McCoy of The Travelers never made any assertion whatsoever that Aspen knowingly presented a false or fraudulent statement in support of its claim. Where?
Steven McCoy then invites Jeff Campu to personally discuss the matter with him, and McCoy gives his phone number. McCoy is all politeness and is not accusatory. However, Jeff Campu doesn’t call McCoy or write him back. He throws the matter to an attorney who writes McCoy with this opening line, “This law firm represents Aspen Medical Resources…” strongly suggesting Campu has a guilty conscience about his billing. It suggests that he had exploitive psychological intentions because without even being accused of anything, he “lawyered-up”.
Jeff Campu’s lawyer, Carol K. Lucas, of the law firm BuchalterNemer, gives an elaborate explanation that there’s no code for a dual-unit. Therefore, Aspen indicated two codes for the dual unit only because that was the closest approximation the biller could devise. She writes close to the end of her letter that there is "...no basis for an assertion that Aspen knowingly presented a false or fraudulent statement in support of its claim..."
Carol K. Lucas leaves out the monetary detail that the billings consistently charged for two units, in the following manner:
CPT: E0217 Water Circulation Heat Pad with Pump DME (Rental for 14 days at $910.00)
CPT: E0218 Water Circulation Cold Pad with Pump DME (Rental for 14 days at $980.00)
Total Rental for 14 days: $1,890.00
Steven McCoy of The Travelers never made any assertion whatsoever that Aspen knowingly presented a false or fraudulent statement in support of its claim. Where? This writer has read McCoy’s very finely and cordially written letter to Jeff Campu over numerous times, and can’t find even a hint of an “assertion” that Aspen knowingly presented a false or fraudulent statement.
Judge Walter Schwarm did not agree to seal the Search Warrant according to Louis Martinez, the DA Investigator’s, request. However, exhibits 4 and 5 were redacted in order to protect the medical privacy of the claimants plus, possibly, the bank statements of Aspen. Henceforth this writer purchased a copy of this Search Warrant, number 5899, at the Orange County Superior Court last Friday, September 14th.
What appears to this writer is that technology ran ahead of the CPT codes and the schedule didn’t have an exact code for a dual unit that could do hot and cold—and go both ways! The units had supposedly always been entirely sep
arate in their functions of hot and cold previously in history. So, Aspen took advantage of this dual hot-cold technological advance and by feigning an inability to choose the right code, they attempted to take advantage—pull a fast one—and double bill for two separate units. And they did it for possibly five years.
It's a truth universally acknowledged that technology makes equipment less expensive rather than more expensive as we move forward into the future....
Any intuitive mind would figure out to charge for one or the other—to charge for one unit—and to stick within the workers’ compensation fee schedule. But clearly, Aspen tried to egregiously exploit, and work the system to their advantage with a double billing. This premeditation was clearly suggested by the fact Jeff Campu lawyered-up and refused to respond to Steven McCoy of The Travelers’ most cordial letter directly.
DA Investigator Louis Martinez’s Internet research revealed the average Water Circulation Hot or Cold with Pump DME unit costs between $295 and $500. Eight photos of the Unit were presented to the Court and referenced as Exhibit #3 although on the photographed documents someone neglected to properly label them as Exhibit #3.
It’s a truth universally acknowledged that technology makes equipment less expensive rather than more expensive as we move forward into the future, and the fact that Aspen was renting one Cold Unit for $980 for 14 days is outrageous enough considering a maximum $500 purchase price tag for such a unit, but then when a dual-unit is invented and Aspen Medical Resources exploits the system with a double billing for two separate units, a hot and a cold, the irresponsibility of such a scam is nothing short of a revelation of over-billing and manipulation of the workers’ compensation system.
Copyright © Lonce LaMon and adjustercom. All rights reserved.