ORANGE COUNTY, Ca. – Over two dozen California doctors, pharmacists, and business owners have been charged for allegedly taking part in a $40 million workers compensation fraud scheme.
Dave Jones the California Insurance Commissioner and the Orange County District Attorney said that the case affected 13000 patients and over 27 insurance companies. The alleged masterminds, Tanya Moreland King, 37, and her husband Christopher King, 38, from Beverly Hills own medical billing and medical management companies including, Monarch Medical Group, Inc., King Medical Management, Inc. and One Source Laboratoires, Inc. The King’s allegedly recruited doctors and pharmacists to prescribe unnecessary treatment for workers compensation patients.
The incidents took place from 2011 to 2015, when the defendants billed for unnecessary creams, tests, and treatments, only to maximize their profits. Through investigation, it was learned that approximately $23.2 million was paid to the defendants, but a total of $40 million was billed to the insurers. The Kings allegedly made oral and written contact with the doctors paying them when they would prescribe a compounded cream or oral medication or order a urine drug test. The payments were labeled “marketing expenses” in order to conceal the kickbacks.
The owners of Steven’s Pharmacy in Irvine, Charles Bonner RPh., 56, and Mervyn Miller, RPh., 66, sold over $1 million in non-FDA approved compound creams to Christopher and Tanya King. These creams were sold to the Kings for between $15-$40 per tube. The products were billed to the workers compensation insurance carriers for between $250-$700 per tube. Some prescribing physicians were paid a flat rate of $50 when prescribed, while others received a share of the profits.
“The Kings and their co-conspirators played with patients’ lives, buying and selling them for profit without regard to patient safety,” said Commissioner Dave Jones. “Patients have the right to expect treatment decisions by health care professionals are based on medical need and not unadulterated greed. The magnitude of this alleged crime is an affront to ethical medical professionals.”
The Kings are also accused of repackaging oral pain medications from two companies through their company, Monarch Medical Group. They allegedly sent the medications directly to the involved physicians and as the medications were dispensed, the bar code on the package was scanned. The Kings never disclosed the wholesale costs or the fact that they purchased the medication on behalf of the physicians who prescribed it. The Kings are accused of splitting the profits with the prescribing physicians based on their agreement with them.
In addition to the other accusations, the Kings were also accused of providing technicians from their company, One Source Labs to the participating physician’s offices. Urine tests were ordered, telling the patients that they were necessary to verify that they were taking their medication as prescribed. These samples were tested by One Source Lab technicians or doctor’s office staff and billed to the insurance on behalf of the physicians by King Medical Management. The results were then referred to Pacific Toxicology Laboratory for additional testing regardless of the results. Pacific Toxicology charge $60 per test, but insurance was billed hundreds of dollars per patient.
“The Orange County District Attorney’s Office will continue to be a leader in the state in prosecuting these types of crimes, because they affect the health of our economy and wellness of our bodies,” stated OCDA Rackauckas. “In order for the system to survive, we must have ethical doctors who abide by their Hippocratic Oath to ‘do no harm.’ The intent of many of the laws surrounding the insurance industry is to keep the three Ps – Physician – Patients – and Profit separate. We have a track record of putting these types of fraudsters behind bars for a long time and we intend to do just that again,” Rackauckas concluded.
