Insurance companies often times accuse policyholders of trying to cheat them. No matter if you are in Dallas, Fort Worth, Arlington, Grand Prairie, or somewhere else, if you make a claim the insurance company will assign an adjuster to investigate the claim. The adjusters job is to evaluate and settle the claim. Sometimes the adjuster finds things that make him suspicious of how legit the claim is. If the adjuster is ever questioning your honesty you should immediately get an experienced Insurance Law Attorney involved.
A big reason adjusters question the honesty of a claim is that occassionally they find something that is just not right. This is illustrated by an article that was published on July 19, 2010, in the Fresno Bee, a newspaper in California. The article is written by Barbara Anderson and is titled, “Valley doctors, chiropractors accused of fraud.”
The article tells us that Allstate Insurance Company is suing San Joaquin Valley doctors and several chiropractors in a multimillion-dollar lawsuit, alleging they falsely operated chiropractic clinics as medical groups to get insurance payments.
The lawsuit in Fresno County Superior Courts also says that the doctors and chiropractors created sham professional medical corporations to illegally purchase and distribute prescription medication to chiropractic clinics and patients.
The lawsuit seeks damages in excess of $3 million as well as statutory penalties. And Allstate seeks more than $1 million in damages, penalties, attorneys fees and costs for violations of California’s Insurance Fraud Prevention Act.
In the lawsuit, more than a dozen defendants are named, including Dolphus Dwayne Pierce II of Lemoore, John Brent Arakelian of Fresno and Drs. Tomas Ballesteros Rios of Bakersfield and Charles Orlando Lewis III of Hanford.
It appears the lawsuit was filed after a lengthy investigation by the fraud investigation unit at Allstate. The defendants say that they have already been checked out and cleared by the California Medical Board.
It is the law in California that chiropractors are not licensed to prescribe or dispense prescription drugs. The lawsuit says the defendants knew this and attempted to get around the law by having licensed doctors prescribe the medication. Doing it this way would increase the value of claims being submitted on behalf of the patients they were treating. The lawsuit alleges that the corporations set up by the defendants, Pierce & Rios Med. Corp., Rios & Pierce Med. Corp. and P&R Med-Legal, were sham corporations, for the purpose circumventing the law.
The lawsuit says that in 2004, Rios entered into agreements with a number of chiropractors to appear as majority owner of multiple medical corporations in exchange for money, to give the false appearance that the corporations were in legal compliance.
Another organization alleged to have been set up to carry on this fraud was, San Joaquin Accident & Medical Group Inc. Yet another entity was known as South Gate.
It is also noteworthy that the article says, Rios pleaded guilty to a felony in making or subscribing to a false income tax return on May 27, 2007.
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