Published: June 13, 2011
Updated: 5:20 p.m.

4 charged with $17 million workers comp fraud

BY VIK JOLLY
THE ORANGE COUNTY REGISTER

SANTA ANA – Orange County District Attorney Tony Rackauckas and California Insurance Commissioner Dave Jones on Monday revealed details of what they said was a $17-million workers' compensation-insurance overbilling scheme run from Buena Park medical offices involving two doctors, an administrator and a bill collector.

The four, including one doctor from Newport Beach accused of being the mastermind, were quietly indicted on May 11; grand jury transcripts in the case were unsealed Monday. The 181 pages of the 884-count indictment were spread out on the floor at the District Attorney's Office as officials discussed the case.

According to prosecutors, charged in the scheme were:

•Dr. Sim Carlisle Hoffman, 59, of Newport Beach, a radiologist and owner of Advanced Professional Imaging, Advanced Management Services, and Better Sleeping Medical Center in Buena Park, faces 883 felony counts of insurance fraud, and one count of aiding and abetting the unauthorized practice of medicine. If convicted, he faces two to 892 years in state prison.

•Beverly Jane Mitchell, 60, of Westlake Village, the administrator in charge of insurance billing for all of Hoffman's businesses, faces the same charges and sentence as Hoffman.

•Dr. Thomas Michael Heric, 74, of Malibu, a neurologist who worked for Hoffman at the medical center, faces 296 counts of insurance fraud and one felony count of aiding and abetting the unauthorized practice of medicine. If convicted, he faces two to 315 years in state prison.

•Louis Umberto Santillan, 44, of Chino Hills, who worked for Hoffman in billing collections at Advanced Professional Imaging, a nerve-testing center, is charged with 141 felony counts of insurance fraud and faces two to 150 years in state prison if convicted.

All four defendants are out on bail.

Among the accusations:

•Hoffman is charged for billing for epilepsy and seizure testing on 1,247 patients without ever conducting these tests on a single patient, Rackauckas said.

•Authorities said that insurance companies were over-billed for performing a painful procedure 20 times when in fact a different, non-invasive test had been done just once.

"These patients were used as pawns in Hoffman's piggy bank," Rackauckas said. "The volume of this scheme leads to one reasonable conclusion – not accidental, but intentional."

Contact the writer: 714-834-3773 or vjolly@ocregister.com

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