adjustercom.com
adjustercom.net
The Stockwell Firm adjustercom publishes your thoughts and ideas...
Home
News

 Features


Other Claims News
People
Forums
The Comp Examiner Directory
The Liability Adjuster Directory
Service Provider Directory
Post a Job
View Jobs
Resumes
View Resumes
Contact Us

Adjusters Friend

jobs.adjustercom.com

 

Place Your Banner Here With A Click

 

adjustercom.net - FraudFromInsideAndOutsideTheCourtroom

 


Welcome Guest! | Login | Register with adjustercom
 
 
News

News Main Page

Email a Friend Email A Friend

More News

March 25, 2024
California Division of Workers' Compensation Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services)

March 19, 2024
Nearly half of all litigated workers' compensation claims in the Los Angeles basin are cumulative trauma claims.

March 7, 2024
California's Division of Workers' Compensation Posts Adjustment to Official Medical Fee Schedule (Ambulance Services)

March 6, 2024
Accident Claims The Life of AdminSure Claims Adjuster Alexis Wicker



Aspen Medical Resources Defendants Jeffrey Campau, Landen Mirallegro, and Abraham Khorshad All Plead Guilty To Workers’ Compensation Insurance Fraud In Orange County Superior Court. Remaining WCAB liens, valued at $139,752,925.77, to be dismissed.
By Lonce LaMon - May 7, 2017

The numbers recovered for the victims by the Orange County District Attorney’s office in this case are just staggering, but let’s set that aside for the moment.

Jeffrey Campau was the first defendant in the late morning on Friday, May 5th 2017, to make his guilty plea in Judge John Conley’s court room, C-30, in Orange County Superior Court.  The judge stated he was taking “Mr. Campo” first.  And so Jeffrey stepped forward; and there he stood, tall and handsome, blue-eyed and in a fine blue suit with a subtle checkered stamp pattern on the fabric, before the court.

 He had a new beard starting up.  It looked like he started growing the beard just a week earlier.  Perhaps the beard was symbolic of his new life and look.  He was breaking out of the past, possibly, and now he was going to live as a bearded man.

Judge Conley said this guilty plea agreement was complicated.   So, he wanted to make sure that Campau, a University of Southern California educated pedigree, understood it well. 

Judge John Conley:  Have you gone through this guilty plea form?  Do you understand…  you have a right to a trial? Finally, in a trial, you have a right to see and hear witnesses…  Has anyone made any threat to you?  Have you entered this agreement freely?


Jeffrey Campau's California Driver's License picture from 2007

Judge Conley explained poignantly to Campau that he was giving up these rights by making this plea deal.  He said the court was going to sentence him to 365 days in the Orange County jail, but with a 10-year state prison sentence hanging over his head. The state prison sentence was suspended pending the successful completion of his jail term along with five years of formal probation.

If he broke the law, if he violated his probation, if he “did something significant”, the judge expressed, he would have to face that 10-year prison sentence. 

He had to give saliva, blood, and finger print samples for the criminal felony database.  He was subject to search and seizure, with a warrant or without a warrant.  He had to cooperate with psychiatric counseling, and he could not possess any firearms.  If he’s asked by a peace officer if he’s on search and seizure, he has to tell the truth.   He could have his car, his home, his anything searched at any time.  Cops can show up any time just to see what he’s up to.  He is going to be under intense scrutiny. 

Judge John Conley:  How do you plead?

Jeffrey Campau:  Guilty, your honor.

Jeffrey didn’t whisper or stammer these three words.  He spoke out clearly and in an audible tone.   Then his business partner, Landen Mirallegro, stepped forward to get the same statements from the judge.  Judge Conley told Landen it was important that he pay attention. 

The judge read the same factual basis to Landen Mirallegro that he read for Jeffrey Campau.  That between November 2009 and July 2013, the defendants violated statutes 550 a8 and 550 a5 by filing multiple claims for the same health care benefit.  They rented to patients (claimants) durable medical equipment that consisted of hot/cold units that were egregiously overcharged and exceeded $70,000,000 in billings.  They received from those billings $10,000,000 in payments.  Landen Mirallegro spoke out clearly as well.

Landen Mirallegro:  Guilty, your honor.

Campau and Mirallegro, both Yorba Linda residents, can apply for home confinement and electronic monitoring to replace getting locked up in the county jail. The program for this GPS electronic monitoring is run by the Probation Department, but they do have to formally apply for it.  It’s not guaranteed they will get approval, however it is highly likely they will be approved.  The jails are crowded and these effete, educated, tattoo-free white collar criminals are thought to be better off locked up in their own homes.

The senior member of the three-way partnership, 65-year-old Abraham Khorshad, got the lightest sentence.  Although he owned 50% of Aspen Medical Resources and National DME, he had nothing to do with Campau’s and Mirallegro’s illegally run Regional Imaging Center dba Elite Diagnostics. 

Elite Diagnostics became a separate case from Aspen Medical Resources when Deputy District Attorney Shaddi Kamiabipour filed a complaint against Campau and Mirallegro on July 14th 2016.  The Aspen indictment came from a grand jury which was filed earlier on October 29th 2013. 

With Aspen, the salient objection came from their astronomical overbilling for a Hot/Cold therapy unit used to treat inflammation and pain.  Aspen was providing a dual unit; and the units held a sale retail value of approximately $225 to $500.  

They were billing it as a rental at 14 day increments, and when a physician prescribed hot/cold therapy, they billed as follows:

CPT: E0217 Water Circulation Heat Pad with Pump DME (Rental for 14 days @ $910.00)

CPT: E0218 Water Circulation Cold Pad with Pump DME (Rental for 14 days @$980.00)

But although the official fee schedule did not have a CPT code for a dual unit, common sense implies that to bill as one hot and another one cold implies two units.  And not only that, but when the client (the payer) replies that the billing doesn’t seem correct and would like it changed, it doesn’t matter what the fee schedule says.  A fee schedule is just a tool to contain costs, not an inexorable gospel.  The Travelers, through Medical Investigator Steven B. McCoy, diplomatically asked Aspen for a conversation on April 19, 2011:

“Based on the billing received it gives the appearance that two separate devices were issued. The adjusters in reviewing these bills relied on this information when issuing payments to your company.  We had this billing reviewed by a certified coder and it’s the opinion of the certified coder that the bills presented may have been incorrectly coded.

“I would like to take this opportunity to personally discuss this matter with you.  I can be reached at 714 *** - **** to set a date and time to meet.”  

He simply wants to personally discuss the matter.  This is a natural, normal human business activity.  If the fee schedule is out of date or style, a mutual agreement can be decided upon between the two parties in order to arrive at a fee which is logical, fair, and appropriate.  Intelligent humans always endeavor to break through out-of-date bureaucracies and make a fair exchange work. 

But Jeffrey Campau would have none of it. His response was not business positive or friendly.  It was defensive and war-like.  His total lack of a warm customer service attitude as a provider towards a payer revealed his belief in his right to take in excess. He was all about manipulating the “system” to get as much as he could exploit.  He was not about making a fair exchange with a customer or cultivating relationship.

His attorney, Carol Lucas, instead of himself, replied to The Traveler’s letter most inappropriately. 

“There was certainly no attempt at concealment and no basis for an assertion that Aspen presented a false or fraudulent statement in support of its claim for compensation,” she wrote.

Steven McCoy of The Travelers never made any “assertion” that Aspen presented a false or fraudulent statement.  He never hinted, suggested, or intimated in any manner that Aspen attempted concealment.  McCoy communicated most properly and generously only that the way the billing was done seemed incorrect, gave the appearance of two machines when there was only one, and most likely needed to be revised.  He most cordially asked for a conversation.  

But Campau with Mirallegro and Khorshad made no compromise.  They dug in their heels and continued to bill in the same way by aggressively defending their billings. 

With Elite Diagnostics it was a matter of DDA Shaddi Kamiabipour running into something else about two years into the Aspen case.  She realized that Elite Diagnostics (Regional Imaging Center) was an LLC and not a Professional Medical Corporation.  This made it illegal for Elite to bill for medical services.  They were only providing the technical aspect—providing MRIs with an MRI machine which was run by non-medical professionals.   The images were sent out to freelance radiologists who simply interpreted the images and wrote the reports from the outside.  But there was neither a medical director nor a supervising radiologist on staff or on site at Regional Imaging – Elite Diagnostics.  Thus, the billings were misleading and illegal.  They were “upcoded” and billed at a code rate for medical services and not as simple technical procedures at a much lesser fee. Plus, they were paying kick-backs for patient referrals. Where would it end? It was another billing fraud.  


Deputy District Attorney Debbie Jackson, left, and Deputy District Attorney Shaddi Kamiabipour, right, leave the Orange County Superior Court on December 2nd 2016 after a hearing for the Aspen-Regional case.  They worked as a magnificent team to bring about $8,621,845.96 in restitution to the workers' compensation payers while securing sentences for the three defendants Jeffrey Campau, Landen Mirallegro, and Abraham Khorshad.  photo by Lonce LaMon, all rights reserved 

Also, on the Statement of Information filing for Regional’s LLC with the California Secretary of State, the business activity was written as:  MRI Scheduling Broker.   On the Anaheim business license, the description was:  Office Use: Broker Services Between Patients and Medical Diagnostic Companies.  More misrepresentation. 

So, while Jeffrey and Landen both pleaded guilty to 55 counts out of the 122 original counts total from both the indictment and the complaint, Abraham Khorshad only pleaded guilty to three counts of medical insurance fraud including an enhancement of aggravated white collar crime over $500,000.00.

Khorshad, clad in a grey suit, with his grey and brown hair, accepted a sentence of nine months in jail with three years of formal probation.  He can’t apply for electronic monitoring in Orange County because he lives in Beverly Hills, but he can apply for the MOST program.  The prosecutor, Shaddi Kamiabipour, looked it up on the Internet and verified it.  Then the court approved it.  Thus, he can get GPS and electronic monitoring through that MOST program.

With his type of sentence he can get his three felony charges reduced to misdemeanors, provided he fully succeeds with his probation.  But an egregious violation of probation would impose upon him up to a maximum of 12 years in prison.  But contrary to Khorshad’s sentence, Campau and Mirallegro cannot get their felonies reduced to misdemeanors ever.  Not even if they pass through their probation with flying colors.  

Jeffrey Campau:  I’m ready to move on with my life.

The joint restitution to be paid by these three defendants is $8,621,845.76.   

The collector, Ryan Mc Cracken, a red-head who started out in 2013 as the fourth defendant in this case, had all the charges recently dismissed against him.  Shaddi Kamiabipour wrote in an email Friday, “I dismissed the case against him in the name of justice.”  McCracken held no ownership in any of the entities at all.

The essential, highly valued result produced in this case by the Orange County District Attorney’s office was the tremendous restitution obtained to reimburse the workers’ compensation payer victims.  The DA had put in place a receiver, Robert Mosier, beginning in 2013 to manage the money and to sell off some of the defendants’ properties after the DA seized the defendants’ assets in order to preserve them for reimbursing the victims.  The Deputy DAs Debbie Jackson and Shaddi Kamiabipour focused hard with the receiver, Robert Mosier, to preserve the cash and assets of the defendants in order to be able to make the victims whole.


Shaddi Kamiabipour is shown here at the April 20th 2017 News Conference in the Orange County DA's library about another fraud case involving Tanya and Christopher King and numerous doctors, whom the OCDA has shut down for fraudulent medical billing and a kick-back operation. Shaddi is now prosecuting that case.  photo by Lonce LaMon, all rights reserved

The companies to receive restitution are:

State Compensation Insurance Fund
Liberty Mutual
AIG
Zenith Insurance Company
American Claims Management
First Comp Insurance
CNA
Comp West
Employers Insurance
Farmers
State Farm
Fireman’s Fund
Tristar (City of Los Angeles)
Gallagher Bassett
Republic Indemnity
Sentry
The Travelers

The defendants agreed to dismiss all remaining liens, valued at $139,752,925.77 at the Workers’ Compensation Appeals Board for the following entities:  Aspen Medical Resources, National Marketing dba National DME, Elite Diagnostics and Regional Imaging Center.


Orange County District Attorney Tony Rackauckas talks to a reporter on April 20th 2017 at his News Conference about the new workers' compensation fraud case he is prosecuting. It also is a multi-million dollar scam.   photo by Lonce LaMon, all rights reserved

The defendants are ordered not to collect on or sell to third parties all healthcare claims submitted to workers’ compensation payers, charged or uncharged, for the aforementioned entities. These receivables collectively exceed $47 million dollars.

The workers’ compensation carriers’ reserves are in excess of $186,752,925.77.  These reserves will be released and the experience modifications of the policy holders will be reduced.

The Orange County District Attorney will provide a letter to the receiver to accompany the restitution payment to each victim demanding that restitution proceeds be distributed to the effected policy holders.

On the Elite Diagnostics-Regional Imaging case, Jeffrey Campau and Landen Mirallegro were also ordered to pay the U.S. Department of Treasury an additional $1,172,491.62.

Each of the three defendants were also ordered to pay a $250,000 fine pursuant to Insurance Code section 1872.83. 

These numbers are really staggering. If any reader thinks the sentences to the defendants are light, realize the tremendous service the OCDA did for the workers’ compensation payer victims and the employers by handing back to them mega-millions of dollars of which they were unduly charged.     

lonce@adjustercom.com, Lonce LaMon, journalist; copyright Lonce LaMon and adjustercom with all rights reserved.  

First published at 6:00 pm on May 7th 2017; minor edits and additions made at 12:45 pm on May 8th 2017.  Then, added the part about the $250,000 fines from each defendant according to the insurance code, as well as the IRS payment from Elite Diagnostics at 6:30 pm on May 8th 2017

 
 

 Hot Jobs


Adjuster / Examiner
Claims Examiner
Santa Ana Unified School District
Santa Ana, CA
View All Jobs

The J Morey Company

Build Your Brand

jobs.adjustercom.com

The J Morey Company


    Copyright 2024 | Privacy Policy | Feedback |  

Web site engine's code is Copyright © 2003 by PHP-Nuke. All Rights Reserved. PHP-Nuke is Free Software released under the GNU/GPL license.