This post was originally published on this site
A former Orange County chiropractor was sentenced to 70 months in federal prison for stealing from health insurers by fraudulently causing the submission of $2.2 million in billings for chiropractic services never provided, medical diagnoses never given, office visits that never occurred, and medical devices that were falsely prescribed.
Susan H. Poon, 57, of Dana Point, was sentenced by United States District Judge David O. Carter, who ordered her to pay $1,379,622 in restitution to her victims.
At the conclusion of a five-day trial in June 2021, a federal jury found Poon guilty of five counts of health care fraud, three counts of making false statements relating to health care matters, and one count of aggravated identity theft.
From January 2015 to April 2018, Poon, whose office was in Rancho Santa Margarita, schemed to defraud health insurance companies by submitting false reimbursement claims for services that were never performed.
Poon also submitted fraudulent prescriptions containing medical diagnoses of individuals that she had never met, including toddlers and children, which led a medical device manufacturer to submit false claims for reimbursement to one health insurer.
The patients that Poon claimed to have met with and treated were dependents – such as the spouses and children – of Costco Wholesale Corp. and United Parcel Service Inc. employees. Poon unlawfully took and used the dependent’s personal identifying information (PII) in her reimbursement requests and prescriptions. Poon obtained the PII by attending health fairs at various UPS warehouses and Costco locations and soliciting such information from employees.
“[Poon’s] scheme consisted of interdependent moving parts,” prosecutors wrote in a sentencing memorandum. “She lied about visits with, diagnoses of, and treatments given to actual people and their children. She sent fraudulent Durable Medical Equipment (DME) prescriptions – predicated on visits with these patients that never happened – to a DME manufacturer. And she fabricated medical documentation containing the personal identifying information of these ‘ghost’ patients to mislead an auditor.”
In total, Poon billed and caused to be billed approximately $2.2 million through her scheme.
Poon’s chiropractic license was revoked in July 2019, according to the California Department of Consumer Affairs.
The following agencies investigated this matter: Amtrak – Office of the Inspector General, California Department of Insurance, U.S. Department of Labor – Employee Benefits Security Administration, U.S. Department of Labor Office of the Inspector General, the FBI, and Office of Personnel Management – Office of the Inspector General.
Assistant United States Attorneys Daniel S. Lim and Daniel H. Ahn of the Santa Ana Branch Office prosecuted this case.
