Physician Charged with Insurance Fraud Arising out of Workers Compensation Submissions
In December 2022 Dr. D. Gary Martinovsky was charged with 40 violations of insurance fraud under (PC 550(a)(5), PC 550(a)(7), and PC 550(a)(8)), for fraudulent billing, double billing, and billing for services not rendered. His mother in law and h is office assistant were also charged. His medical corporation, Integrated Pain Care (IPC) was charged as well.
When a medical corporation is charged different rules as to privilege apply. Individuals who work for or own the corporation still retain their personal rights but the Fifth Amendment’s right against self incrimination applies only to real people (natural persons) and not corporations. (See Braswell v. United States (1988) 487 U.S. 99 https://supreme.justia.com/cases/federal/us/487/99/
This means that all corporate records have to be turned over even if they incriminate the physician owner. The doctor who runs the corporation is not “himself/herself”, the doctor is an agent of the corporation so privileges not personal to the doctor do not apply.
In Dr. Martinovsky’s case the charges arise from a violation of California’s generic insurance fraud statute, Penal Code section 550. He was charged with 40 violations of insurance fraud under (PC 550(a)(5), PC 550(a)(7), and PC 550(a)(8)). Specifically the prosecution alleged fraudulent billing, double billing, and billing for services not rendered.
Even though the charges do not arise under a specific Workers Compensation statute the claims are filed based upon liens filed with the State of California Division of Workers Compensation. Part of the charges are duplicate billing based with allegations that submissions were intentional made seeking reimbursement for work which had already been paid (in whole or in part).
in full or in part.
The prosecution also claims that Dr. Martinovsky and billed for services not actually provided. The news releases do not yet disclose full details but you can be certain that numerous undercover agents went to the medical practice.
In large cases such as this, the investigation and the undercover operations are directed by the State Department of Justice in conjunction with the California Department of Industrial Relations. The process is usually started by insurance companies through their own investigations and complaint(s). In this particular case the news release indicates that the case was developed through an investigation conducted by the San Francisco District Attorney’s Office Economic Crimes Unit, with the California Department of Insurance assisting in the arrests.
There are many defenses to Penal Code section 550 charges. Some are highly technical and others focus on how insurance companies fund and profit from criminal charges filed against doctors. Remember that any large billing operation will make errors. Honest mistakes or disagreements on medical issues are not crimes. For people such as Dr. Martinovsky, his family and staff the mere filing of charges is devastating.
If you are under investigation you need immediate legal asisstance.
The Horowtiz law office is highly experienced in medical fraud defense. Over 15 years ago the Horowitz office won a medical fraud case at trial where Dr. Martinovsky was (not charged) but providing services to patients of the charged medical office. If you are facing medical fraud charges Daniel Horowitz is your first choice.