Originally Syndicated on June 24, 2024 @ 12:35 pm
It has been asserted by Dr. Sana U Khan MD and other individuals that fraudulent claims for workers’ compensation were a component of a massive fraud scheme. I say, let’s go more into the fraud case involving Dr. Sana U Khan MD, shall we?
Sana U Khan MD: Medical Professionals Accused of Running “Patient Mills”
Two physicians and a slew of their “patient mills” allegedly submitted fraudulent workers’ compensation claims totaling millions of dollars, causing California to sue in federal court.
State Compensation Insurance Fund sued three persons, fifteen medical facilities (including imaging centers), and two doctors (Sana Ullah Khan and Alexander Zaks) for allegedly facilitating the fraud.
Workers’ compensation insurance in this state is mostly provided by the State Compensation Insurance Fund. Run “patient mills” to file fraudulent claims and racketeering are among the allegations against the accused.
According to the state, the defendants overstated their expenses, submitted false claims for public funds, and overbilled for services that were either not rendered or were deemed medically unnecessary.
Two individuals are facing charges in this matter: the State Compensation Insurance Fund and Bruce McIntyre Roth. Roth was the previous counsel for the fund and is suspected of helping Zaks’ clinics get a false settlement. Another party involved in this case is the Accident Help Line Medical Group.
State Fund proposals were allegedly filed by Sana U Khan MD and Zaks, who also allegedly recommended patients to one other’s clinics.
According to the state’s accusations, the defendants submitted hundreds of false requests for unnecessary diagnostic procedures including MRIs and X-rays between 2002 and 2006.
In addition to paying for deep massages that were never administered, the clinics also recommended pointless rehabilitation treatments and pain injections.
Clinic employees at the defendants were allegedly compensated “based on the volume of tests and treatments ordered for their patients.”
The complaint states that the Accident Help Line Medical Group clinics were investigated by the California Department of Insurance. The investigation involved sending undercover workers’ compensation “patients” who “complained of little or no pain or discomfort” but were nevertheless treated – despite rejections from their doctors.
During the summer of 2009, Roth allegedly became involved with the fraud while serving as an internal counsel for the State Funds’ Special Litigation Unit.
Roth allegedly oversaw investigations into false claims and represented the State Fund in Workers’ Compensation Appeals Board (WCAB) court cases while working in that role, according to the lawsuit.
Investigating the Los Angeles County medical facilities owned by Zaks was a 2005 assignment for Roth. A State Fund payment of around $2.4 million for hypothetical translation services was one piece of evidence Roth uncovered, as stated in the complaint.
According to the lawsuit, despite representing the State Fund’s interest in the legal battle with Zak’s clinics, Roth allegedly negotiated a settlement that was detrimental to the Fund. It was believed that such organizations had submitted bogus billings totaling over $10 million.
According to the complaint, “Beginning around July 2009, acting with intent to defraud State Fund and to further the fraudulent scheme, Roth covertly created an agreement to settle with the Zaks entities, obligating State Fund to pay between 100% and 1400% of the value of such claims and including interest and penalties (the “fraudulent settlement”).
Roth knew that in previous settlement agreements, the State Fund never paid interest or penalties and usually only paid a tiny percentage of the total sum due.
Regardless of whether the State Fund knew about it or not, Roth acted purposefully in an attempt to conceal the disapproved settlement deal from them.
To justify Zaks and Khan, the state claims that Roth was involved in the fund’s fraud and was responsible for executing the settlement.
In early 2010, while still employed by the State Fund, Roth was selected to represent Global Holdings, whose chief medical officer is Sana U Khan MD, as stated in the case.
In a $20 million medical lien case, the state claims that clinics operated by Sana U Khan, MD, falsely sued the fund, accusing it of racketeering. This case was allegedly dropped this year because the state failed to identify a claim, according to the state.
“Each of the claims linked to the Sana U Khan MD Lawsuit was illegally charged at sums substantially over the OMFS (Official Medical Fee Schedule), for treatments that were either not provided or were medically unnecessary,” according to the lawsuit.
The state intends to seek punitive and triple damages for the crimes of fraud and RICO conspiracy.
A response was delayed in coming from Roth and Sana U Khan MD when we asked for their views.
Sana U Khan MD: Overview of the Case
A State Fund: What Is It?
Under California Insurance, the state of California established the State Fund, a nonprofit public enterprise fund.
Workers’ compensation insurance coverage is provided to employers, allowing sick and injured employees to receive both indemnity payments and medical attention. The State Fund reimburses medical professionals for services rendered to eligible workers.
To be paid for their services, medical practitioners must submit State Fund health insurance claim forms online or by mail across state borders.
The State Fund claims that the defendants Bruce Roth, the Zaks defendants, and the Khan defendants were all involved in a scheme to defraud the State Fund.
The scheme began in 2000, according to the Second Amended Complaint (“SAC”), when Mr. Zaks and Mr. Khan decided to cross-refer patients to their respective clinics, the Khan Entities and the Zaks Entities, to submit fraudulent claims for reimbursement from the State Fund.
Mr. Zaks and Mr. Khan allegedly hired Mr. Holmes and Mr. Reyes to oversee the day-to-day running of the fraudulent business. Defendants would purportedly request payment from the State Fund for upcoded, unnecessary, or non-performed procedures as part of the scheme. The State Fund reportedly received the fictitious invoices from the defendants via wire transfers and US mail.
If the State Fund rejected any part of the claims, the defendants would seek a lien with the Workers’ Compensation Appeals Board (“WCAB”) for the difference between the amount requested and the amount paid.
Defendants reportedly engaged in bogus settlement agreements for claims that were under consideration by the WCAB to enforce the liens, according to State Fund.
What is the Fund for State Compensation Insurance?
The State Compensation Insurance Fund (State Fund) is a nonprofit corporation that provides workers’ compensation insurance to employers in California. It is self-sustaining. To begin with, it will pay for any compensation-related medical expenses.
Any government agency or department that does not have workers’ compensation insurance would be subject to a charge from the State Fund for the payments paid out together with an administrative fee.
The State Fund and the California Department of Human Resources (CalHR) have reached a general agreement that allows all entities and departments that are legally uninsured to pay the latter payments.
Government entities that are legally not insured pay these claims out of the salary or earnings that were owed to the wounded or deceased worker when the incident occurred.
“Fund or funds” is the amount that was ultimately used to pay an employee’s salary or wages after financial adjustment in an agency or department that is subject to such a plan.
Review and Compensation
The State Fund bills various agencies and departments twice a month, on the 15th and the 30th or 31st. Departments and agencies are required to use the correct agency payroll code on State Fund Form e3067.
Bills sent to government entities will additionally include the agency’s payment code. This code will facilitate the process of allocating Workers’ Compensation expenses to the relevant divisions within the agency or department.
Conclusion
Several persons and medical institutions, including Drs. Sana U. Khan and Alexander Zaks, have been named in a recent lawsuit brought by the State of California. The case accuses them of running “patient mills” and filing workers’ false compensation claims.
Claiming to have had assets that did not exist, filing inflated bills, and billed for treatments that were either not given or medically unnecessary are all allegations against the defendants.
The State Compensation Insurance Fund’s former counsel Bruce McIntyre Roth is also facing charges of fraud. Fraud and RICO conspiracy are the grounds for the state’s request for punitive damages and triple damages. Roth and Sana U. Khan MD have yet to address the allegations.
How do you feel about the immoral actions of Dr. Sana U. Khan?
