Backlash

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Fraud sometimes causes adverse reactions from those it victimizes. The State of California’s Workers’ Compensation program couldn’t take the numerous instances of fraud against the program anymore and retaliated with “Operation Backlash.”  Today’s fraudster, a Beverly Hills radiologist, was one of the many perpetrators of a workers’ compensation fraud scheme brought to justice as a result of this four-year multi-agency undercover operation initiated to combat corruption within the state’s workers’ compensation system.

The Beverly Hills radiologist owned two corporations that operated clinics in 13 California locations. He fraudulently billed insurance companies for more than $25 million of medical services including MRIs, ultrasounds, Shockwave treatments, toxicology testing and prescription pain medications. (He beefed up his number of patients by paying kickbacks to various individuals, for referring workers’ compensation patients his way.)

One of the deceptive doctor’s companies was responsible for fraudulently billing the insurance companies for the procedures. (The company did not reveal to the patients nor the insurers that substantial kickbacks had been paid. This is definitely a violation of California law.) The other company funneled the kickback payments to those who were sending the referrals. Trial evidence revealed that the doctor paid more than $100,000 in bribes for the increased business. (Apparently, he sometimes paid bribes based on a per-patient or per-body-part formula. I wonder which body part fetched the highest price?)

Following a seven-day trial, the jury found the Beverly Hills, California doctor and his companies guilty of workers’ compensation fraud. He was sentenced to 10 years in federal prison.

Since November 2015, “Operation Back Lash” has charged nearly 40 individuals and corporations – including doctors, attorneys, marketers and medical providers – with federal and/or state crimes. Additional research discovered that four other defendants, who were charged with the doctor for allegedly receiving bribes in exchange for patient referrals, have all pleaded guilty and are cooperating with the investigation while waiting to be sentenced. (Congrats to all the agencies involved in this operation for having the best interest of the patient in mind, not the highest bidder.)

Today’s “Fraud of the Day” is based on an article entitled, Beverly Hills doctor gets 10 years in federal prison for workers’ comp scam,” published by The San Diego Union-Tribune on June 18, 2018.

A Beverly Hills radiologist was sentenced to 10 years in federal prison Monday for his role in a massive fraud scheme that doled out kickbacks for patient referrals for bogus tests at a network of clinics he owned across the state including San Diego and Imperial counties.

Dr. Ronald Grusd was convicted in December by a federal jury in San Diego of 39 charges, including conspiracy, honest services wire and mail fraud and health care fraud

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.