{"id":28885,"date":"2017-01-16T14:28:29","date_gmt":"2017-01-16T22:28:29","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=28885"},"modified":"2017-01-16T14:28:29","modified_gmt":"2017-01-16T22:28:29","slug":"union-member-sentenced-to-41-months-for-fraudulently-billing-for-chiropractic-services","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=28885","title":{"rendered":"Union Member Sentenced to 41 Months for Fraudulently Billing for Chiropractic Services"},"content":{"rendered":"<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\"><strong>LOS ANGELES<\/strong><\/span><\/p>\n<hr \/>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-15368 alignleft\" src=\"https:\/\/cjnotebook.com\/wp-content\/uploads\/2015\/09\/Courtroom.jpg\" alt=\"Courtroom\" width=\"200\" height=\"181\" \/>A<span style=\"font-size: 14pt;\"> federal judge sentenced a member of the International Longshore and <\/span>Warehouse Union<span style=\"font-size: 14pt;\"> or ILWU, Local 13, to 41 in prison for causing two medical clinics to bill the union\u2019s health care plan for chiropractic services that were not provided or were not medically necessary.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\"><strong>David Gomez<\/strong>, 53, of San Pedro, submitted more than a quarter-million dollars in bills to the union&#8217;s health care plan for the chiropractic services, according to officials.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">Gomez was convicted in October of 20 counts of mail fraud. Gomez has been in custody since a federal jury returned its guilty verdicts.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">The ILWU represents dockworkers at the ports of Los Angeles and Long Beach. Members of the union receive benefits, including health care benefits, through the ILWU-Pacific Maritime Association Welfare Plan.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">\u201cBy defrauding the health plan of his fellow union members, Gomez betrayed and abused the trust of the very people his clinics purported to serve. Though this case is a sobering reminder of the often shameless nature of fraud schemes, today\u2019s sentence sends a stern warning to those who would line their pockets at the expense of health plan participants and sponsoring employers. The Office of Inspector General will continue to work with our law enforcement partners to investigate the theft of union benefit plan assets,\u201d stated Abel Salinas, Special Agent-in-Charge of the Los Angeles Office, Office of Inspector General, U.S. Department of Labor.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">According to the evidence, Gomez and his co-defendant, Sergio Amador, opened a clinic in Long Beach in 2009 that operated under the name Port Medical and provided medical and chiropractic care.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">The next year, they opened a second clinic operating under the same name in San Pedro.<\/span><\/p>\n<figure id=\"attachment_7271\" aria-describedby=\"caption-attachment-7271\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-7271\" src=\"https:\/\/cjnotebook.com\/wp-content\/uploads\/2014\/11\/Fraud-Image-300x198.jpg\" alt=\"FBI Photo Image\" width=\"300\" height=\"198\" srcset=\"https:\/\/cjnotebook.com\/wp-content\/uploads\/2014\/11\/Fraud-Image-300x198.jpg 300w, https:\/\/cjnotebook.com\/wp-content\/uploads\/2014\/11\/Fraud-Image-90x60.jpg 90w, https:\/\/cjnotebook.com\/wp-content\/uploads\/2014\/11\/Fraud-Image-180x120.jpg 180w, https:\/\/cjnotebook.com\/wp-content\/uploads\/2014\/11\/Fraud-Image-95x64.jpg 95w, https:\/\/cjnotebook.com\/wp-content\/uploads\/2014\/11\/Fraud-Image.jpg 353w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-7271\" class=\"wp-caption-text\">FBI Photo Image<\/figcaption><\/figure>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">Gomez and Amador also created medical management companies that they used to receive funds generated by the medical clinics, which they then used to pay themselves and to pay incentives to ILWU members to use, and encourage other ILWU members, to use the Port Medical clinics.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">These incentives were often paid as \u201csponsorships\u201d of basketball or softball teams, with the understanding that the ILWU member receiving the \u201csponsorship\u201d would visit, and encourage other team members to visit, Port Medical.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">According to the evidence, Port Medical chart entries were falsified to indicate that ILWU members and their dependents, including children as young as 5 years old, had received repeated chiropractic services, including multiple sessions of massage therapy, that they had not, according to authorities.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">To accomplish this, ILWU members were asked to sign their names on multiple sign-in stickers that were used to create the fabricated chart <\/span>entries,<span style=\"font-size: 14pt;\"> or their signatures on stickers affixed to the chart entries were simply forged.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">Other evidence related to instructions provided to Port Medical massage therapists on how to craft chart entries to maximize billing and make services appear to be medically necessary, a requirement for them to be covered by the ILWU-PMA Welfare Plan, according to officials.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">Included were instructions to massage therapists never to write that a patient had indicated \u201cno complaints,\u201d and to make sure not to copy or write chart entries \u201cexactly the same each time, change things up a little!!!\u201d<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">Over the life of the fraudulent scheme, the medical management companies controlled by Amador and Gomez received at least $3 million that derived from funds paid by the Welfare Plan to Port Medical.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">\u201cDefendant Gomez concocted an elaborate scheme to enrich himself at the expense of his colleagues, their families and the insurance plan that protected their health,\u201d said Deirdre Fike, the Assistant Director in Charge of the FBI&#8217;s Los Angeles Field Office. \u201cThis successful prosecution was the result of a long-term effort by agents and prosecutors dedicated to combating health care fraud.\u201d<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">Amador pled guilty earlier this year to one count of mail fraud and is scheduled to be sentenced in April, according to officials.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 14pt;\">The case against Gomez and Amador was investigated by the U.S. Department of Labor \u2013 Office of Inspector General, Office of Investigations; the U.S. Department of Labor \u2013 Employee Benefits Security Administration; and the Federal Bureau of Investigation.<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>LOS ANGELES A federal judge sentenced a member of the International Longshore and Warehouse Union or ILWU, Local 13, to 41 in prison for causing two medical clinics to bill the union\u2019s&#8230;<\/p>\n","protected":false},"author":1,"featured_media":27401,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,3],"tags":[],"class_list":["post-28885","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-home-main-slider","category-u-s-department-of-justice"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Union Member Sentenced to 41 Months 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