Chiropractic Insurance Fraud Conspiracies Cracked by Minnesota Commerce Fraud Bureau and FBI

Chiropractic Insurance Fraud Conspiracies Cracked by Minnesota Commerce Fraud Bureau and FBI

Chiropractic Insurance Fraud Conspiracies Cracked by Minnesota Commerce Fraud Bureau and FBI

U.S. Attorney’s Office
District of Minnesota
21 December 2016

FOR IMMEDIATE RELEASE

Chiropractors billed “no-fault” insurance policies for more than $20 million dollars

United States Attorney Andrew M. Luger today announced federal criminal charges filed against 21 defendants for conspiring to commit health care fraud. The defendants, charged by four indictments and two felony informations, fraudulently billed insurance companies for millions of dollars over the course of the parallel conspiracies.

“State and federal law enforcement are cracking down on no-fault automobile insurance fraud,” said U.S. Attorney Luger. “The charges unsealed today represent a serious effort to expose crooked billing abuses that harm consumers. The Commerce Fraud Bureau and FBI continue to work closely with my office to ensure that our efforts to stop fraud and abuse are aligned with the interests of all Minnesotans.”

“Today’s charges send a clear message to criminal networks that committing insurance fraud will result in a concerted effort by the FBI and our law enforcement partners to bring those responsible to justice,” said Special Agent in Charge of the FBI Minneapolis Division Richard T. Thornton. “Fraud schemes perpetrated by those in the health care sector not only undermine public trust and betray the medical profession, but also result in the theft of funds earmarked to cover legitimate health care expenses. For these reasons, the FBI will continue to aggressively investigate all forms of insurance fraud to include the types of schemes charged today.”

“We will not tolerate those who perpetrate staged car accidents, illegal kickbacks, nor fake medical billing,” said Commerce Commissioner Mike Rothman. “Today’s crackdown will help stop these fraud schemes that threaten our public safety and prey on Minnesota consumers. I commend the great teamwork among our Commerce Fraud Bureau, the U.S. Attorney’s Office, and the FBI, with the assistance from partners in state and local law enforcement agencies, which are focused on stopping these kinds of criminal schemes.”

Under the Minnesota No-Fault Automobile Insurance Act, auto insurance policies must include a personal injury protection provision (PIP). The PIP provision carries a minimum coverage amount of $40,000 for expenses resulting from injuries sustained in an automobile accident, $20,000 of which may be used for medical expenses.

According to the charging documents, at various times between at least 2010 and 2015, chiropractors PRESTON E. FORTHUN, ANGELA A. SCHULZ, HUY NGOC NGUYEN, ADAM J. BURKE, and other Doctors of Chiropractic, engaged in schemes with others to defraud automobile insurance companies. The schemes, which were nearly identical fraud schemes largely carried out independent of one another, involved the submission of fraudulent no-fault insurance claims.

According to the charging documents, chiropractors involved in the scheme would submit claims and receive reimbursements for chiropractic services that either were not medically necessary or were never rendered. Each chiropractor would prescribe and purportedly provide services that were not determined medically necessary by the physical condition of each patient, but were instead designed to fraudulently maximize reimbursement from the patients’ automobile insurance companies.

According to the charging documents, in order to get more patients to come to chiropractic appointments for treatment they did not need, the chiropractors charged would make illegal payments to patient recruiters, known as “runners.” Runners typically made upwards of $1,000 per automobile accident patient in exchange for bringing the patient into the chiropractor’s office. Runners were often not paid, or paid only in part, until after the patient had attended a minimum threshold number of treatment sessions. In order to keep the patients coming back for medically unnecessary appointments, the runners often paid illegal kickbacks to the patients.

According to the charging documents, some of the charged chiropractors would conceal the kickback payments in various ways. For example, FORTHUN wrote checks to runners and falsely described those checks on the memo lines as payments for services such as “transportation” or “marketing.” Defendant BURKE encouraged runners to form corporate entities such as LLCs with names that sounded like legitimate businesses to which BURKE made kickback payments. And defendant NGUYEN tried to conceal kickback payments by making checks out to “cash” for several thousand dollars. He often wrote multiple such checks each week, falsely characterizing them as having been for “chiropractic supplies” of “office supplies.”

This case is the result of an investigation conducted by the Minnesota Commerce Fraud Bureau and the FBI. Additional assistance was provided by the Minneapolis Police Department, Saint Paul Police Department, Minnesota State Patrol, and Homeland Security Investigations.

This case is being prosecuted by Assistant U.S. Attorneys David M. Maria and John E. Kokkinen.

Defendant Information:

Chiropractors

ANGELA A. SCHULZ, 47
Chaska, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

PRESTON E. FORTHUN, 38
Bloomington, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

HUY NGOC NGUYEN, 42
Brooklyn Park, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

ADAM JOHN BURKE, 32
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

Runners

ABDISALAN ABDULAHAB HUSSEIN, 48
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 2 counts
• Conspiracy to commit mail fraud, 2 counts

SAHAL ALI WARSAME, 35
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 2 counts
• Conspiracy to commit mail fraud, 2 counts

YAHYE MOHAMED HERROW, 45
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

TEMITAYO IFELOJU OLUSHOLDA DANIEL, 35
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

MERRON REDI SAMUEL, 36
Saint Paul, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

ABDIRAHIN KHALIF IBRAHIM, 25
Saint Paul, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

DANA ENOCH KIDD, 35
Elk River, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

SAMATAR HASSAN OMAR, 28
Edina, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

ABDINASIR MAYON ABIKAR, 31
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

ALI M ABIKAR, 28
Edina, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

DANA STEPHEN COMEAUX, 57
Brooklyn Center, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

CARLOS PATRICIO LUNA, 48
Minneapolis, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

JEROME TARLVE DOE, 52
Brooklyn Park, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

NAPOLEAN TUTEX DEAH, 32
New Brighton, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count

SAMMANY RATHY SPANGLER, 27
Woodbury, Minn.

Charges:
• Conspiracy to commit health care fraud, 1 count
• Conspiracy to commit mail fraud, 1 count