In mid-December, a federal jury found Ronald Grusd and two corporations, California Imaging Network Medical Group and Willows Consulting Company, guilty of fraud and bribery related to a health care fraud scheme involving California’s Workers’ Compensation program. More specifically, the jury was found guilty of Conspiracy, Honest Services Mail and Wire Fraud, Health Care Fraud, and violations of the Travel Act. Grusd, the companies, and his administrator, Gonzalo Paredes, were indicted by a federal grand jury in November 2015. Grusd will return for sentencing in March 2018. Paredes is to return to court for a hearing regarding a retrial in January 2018.
Grusd’s Health Care Scheme
Grusd and his two companies paid kickbacks to multiple clinics in San Diego County and Imperial County for patient referrals. The purpose of these illegally obtained patient referrals was to fraudulently bill insurers more than $25 million in medical services.
Once Grusd received a patient referral for a treatment or service, California Imaging Network Medical Group would fraudulently bill insurers for procedures. Willows Consulting Company paid the kickbacks to the physicians and other individuals at the various clinics who referred patients to Grusd and his companies. He and the company did not acknowledge to patients or insurers that kickback payments were involved. Grusd received hundreds of illegal referrals based on his kickback scheme and paid more than $100,000 in bribes to secure unlawful billing practices.
Grusd also negotiated with several people, including primary care physicians, for referrals of workers’ compensation patients that could lead to claims for MRIs, ultrasounds, toxicology tests, pain medication, and Shockwave treatments. Since 2009, he and his companies filed tens of thousands of liens in the state’s Workers’ Compensation System, asking for reimbursement for hundreds of millions of dollars.
Grusd’s Scheme Discovered During Operation Back Lash
While many schemes like this are discovered through qui tam suits, which are brought by private individuals who have incriminating evidence, Grusd’s health care fraud scheme was discovered during Operation Back Lash, which is a proactive health care fraud investigation looking into fraud in California’s Workers’ Compensation system, run by the U.S. Attorney’s Office, the San Diego District Attorney’s Office, the Federal Bureau of Investigation, and the California Department of Insurance.
“A patient entrusts his life to his physician,” stated U.S. Attorney Adam Braverman. “A doctor’s medical decisions should be based on the best interest of the patient, not the highest bidder. The jury has found that Dr. Grusd perverted that sacred relationship by buying and selling patients – oftentimes on a per-body-part basis – for his own personal enrichment.”
The operation led to four defendants being charged with crimes, in addition to Grusd and Paredes. They pleaded guilty to receiving bribes in exchange for patient referrals and are cooperating with the authorities while they await sentencing.
Do You Have Information About Health Care Fraud?
If you work in the health care industry in California and you have information regarding a health care scheme that recovers money from a federal or state health care program, contact a San Francisco health care fraud attorney at Brod Law Firm. You may have the right to file a qui tam suit on behalf of the government. If the state or federal government is successful in obtaining a settlement or jury award based on your information, you may receive a part of the financial recovery.
(image courtesy of Hush Naidoo)