Suburban chiropractor gets prison time for healthcare billing fraud
A Northbrook man who owned several chiropractor clinics in the north suburbs was sentenced Tuesday to spend 20 months in federal prison for his role in a health care fraud scheme, the U.S. attorney's office for the Northern District of Illinois announced Wednesday.
U.S. District Judge Ronald Guzman cited 46-year-old Steven Paul's "extraordinary cooperation" in the government's investigation as a basis for imposing what he said was the lowest possible term of imprisonment he would consider, according to a news release from the U.S. attorney's office.
Federal court records indicate that Paul, along with others, was indicted back in 2011. He pleaded guilty in 2012 to one of four counts of health care fraud, while the rest are being dismissed.
Court records show that a pre-sentence investigation report was filed in July 2014. In May 2015, Paul moved to withdraw his plea, and that motion was formally denied in December 2016.
The plea deal filed in 2012 says Paul admitted that from 1999 to 2008, he directed billings to Blue Cross Blue Shield of Illinois totaling $3.65 million for medically unnecessary tests or physical therapy services that were not provided, and his clinics collected $1.33 million in fraudulent reimbursements from the insurance company.
Co-conspirators named in the indictment were Bradley Mattson and Neelesh Patel.
Paul and Mattson jointly owned six chiropractic clinics in the north suburbs of Chicago, according to court documents. They were: Hawthorn Physical Medicine in Vernon Hills; Woodfield Physical Medicine in Schaumburg; Stratford Physical Medicine in Bloomingdale; Algonquin Physical Medicine in Lake in the Hills; Northshore Physical Medicine in Niles; and Cumberland Physical Medicine in Norridge.
According to the government, an undercover FBI agent visited the Hawthorn clinic for treatment of a back strain, and Mattson diagnosed the agent with a pinched nerve and ordered a treatment plan that began with daily visits for two weeks. The clinic's medical doctor and a physical therapist, however, were of the opinion that the agent instead had a pulled muscle, the government said.
Mattson, of Lake Forest, initially faced 19 counts of health care fraud. He also pleaded guilty to one count and was sentenced in 2012 to spend six and a half years in prison.
Patel was charged with more than a dozen counts of health care fraud as well.
Court records indicate he and the government entered into a deferred prosecution agreement in March 2014 that gave him 12 months to demonstrate good conduct.
One of the conditions of the agreement was that he pay $87,852 in restitution to Blue Cross Blue Shield of Illinois, sharing the responsibility of that payment with Mattson, who had already been sentenced.
Also as part of the deferred prosecution agreement, Patel agreed to admit that between March 2004 and December 2007, he jointly owned and operated the Schaumburg and Bloomingdale clinics with Mattson and Paul and billed at least $245,582 for physical therapy services performed by someone who didn't work at either clinic. The billing led to the clinics being reimbursed the restitution amount for the fictitious services.
In March 2015, an order was entered saying Patel complied with all the terms and conditions of the agreement, and all counts filed against him were dismissed.