Feds indict 9 in $950m Operation “Spinal Cap” fraud case

US federal prosecutors with the Department of Justice this week unsealed charges against nine new defendants they claim are part of a long-running healthcare fraud case responsible for more than $950 million in fraudulent claims.

The fraud scheme was reportedly run by former Long Beach, Calif.-based Pacific Hospital owner Michael Drobot, who was involved in more than $40 million in illegal kickbacks paid to medical professionals in exchange for referrals for patients who received treatment at the hospital, according to a DoJ release.

Included in the charges are Pacific Hospital orthopedic surgeons Daniel Capen, Timothy Hunt and Tiffany Rogers, former Pacific Hospital physician management CFO George Hammer, chiropractors Lauren Papa and Brian Carrico, and Willian Parker.

Capen, Hunt, Hammer and Papa have agreed to plead guilty for their parts in the scheme, according to the DoJ release.

The Department of Justice said that fraudulent claims related to the scheme span a 15-year period and cumulatively total more than $950 million.

The investigation is being conducted by the FBI, IRS Criminal Investigations, the California Department of Insurance and the US Postal Service’s Office of Inspector General.

“Public health insurance programs – whether a workers’ compensation program or Medicare – are not a personal pocketbook for criminals seeking to exploit government programs designed to help those who need these plans the most. Taxpayers rightly expect individuals working in the healthcare industry that receive payments from taxpayer-funded programs to scrupulously follow the rules. IRS Criminal Investigation will continue to protect the integrity of public health insurance programs and ensure that doctors, pharmacists and medical service providers who profit from these illicit schemes are held accountable,” IRS Criminal Investigation special agent in charge of the Los Angeles Field Office R. Rowe said in a prepared statement.

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