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California Radiologist Faces 884 Felony Counts

June 15, 2011
Written by: , Filed in: Medical Ethics, Neuroradiology, Practice Management
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A radiologist from Newport Beach, California, has been charged with 883 felony counts of insurance fraud (totaling more than $17 million) and one felony count of aiding and abetting the unauthorized practice of medicine. His maximum possible sentence is 892 years and eight months.

Sim Carlisle Hoffman, MD, is accused of carrying out the fraud at Advanced Professional Imaging (API) and Better Sleeping Medical Center (BSMC), both of which are in Buena Park, California, and both of which he owns. Also indicted were Thomas Michael Heric, MD, a neurologist who worked for Dr. Hoffman at BSMC, as well as administrator Beverly Mitchell and bill collector Louis Santillan.

All four are out on bail—$1.5 million in Dr. Hoffman’s case. As a condition of bail, Drs. Hoffman and Heric must face the Medical Board of California for possible license revocation.

A grand jury returned the indictment on May 11, and the indictment was unsealed on Monday. The OC Weekly did a comprehensive story, including the full text of the district attorney’s remarks.

The district attorney said Dr. Hoffman was disciplined by the Medical Board in 2001 “for similar unethical medical practices.” And Dr. Heric’s license was suspended for 60 days in 2008 for a federal fraud conviction involving Medicare and Medi-Cal (the state health-insurance program for low-income, disabled, and elderly Californians).

The latest indictments cover two separate frauds. At the sleep center, the district attorney said, Dr. Hoffman billed worker’s compensation insurance for epilepsy and seizure testing on 1,247 patients during a one-year period, 2007–2008. The indictment says the sleep center never actually tested or treated any of the patients.

The second fraud involves conducting single fiber electromyogram (EMG) nerve tests—billed at $330 per procedure—when, according to the district attorney, a simple EMG (billed at $35) would have sufficed. The district attorney described the regular EMG as “a noninvasive outpatient procedure” and single fiber EMG as “an invasive, painful procedure, often needing hospitalization to prevent bleeding and infection.”

He may have exaggerated a bit about the pain and invasiveness. However, single fiber EMG is a specialized test, used primarily for diagnosing myasthenia gravis, and it is normally done only by specially trained and very experienced physicians. Said the district attorney:

Only two doctors in California are qualified to perform this test because it is so complex and requires specialized training. Hoffman is not one of those two doctors.

The district attorney said Dr. Hoffman performed the test on some patients more than 20 times each. “Most of the patients,” he said, “were blue-collar workers, and the majority were Spanish-speaking.”

If Dr. Hoffman was committing fraud, he was pretty brazen about it. He sued Zenith Insurance Company in federal court, alleging that it violated the U.S. Racketeer Influenced and Corrupt Organizations (RICO) Act by failing to pay some claims that the insurer suspected were fraudulent.

The judge ruled in February for the insurance company.

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