A group of doctors, pharmacists, and medical billing professionals have recently been accused of fraud due to their dealings with a massive workers compensation fraud ring in Southern California.
It all started when medical billing specialists Tayna Moreland King and her husband Christopher King decided to create a complex insurance fraud scheme from the comforts of their own business. They used their medical billing and coding companies, Monarch Medical Group, Inc, King Medical Management, Inc. and One Source Laboratories, Inc., to reach out and appeal to doctors and pharmacists to prescribe unnecessary treatment for workers compensation patients.
According to CBS the ring, which ran between 2011 and 2015, was worth $40 million dollars. This reckless ring affected more than 13,000 patients and 127 insurance carriers throughout the state of California.
The report, which was released by the Orange County District Attorneys Office, only names one co-conspirator, pharmacist Charles Bonner owner of Stevens Pharmacy in Costa Mesa, California. The Kings worked with Bonner to create a cream to be used for medical purposes, with unknown side effects that were not approved by the U.S. Food and Drug Administration.
The Kings bought the cream at a rate of between $15- $40 a tube, then went on to sell it to patients for between $200 to $700 dollars a tube. They would entice doctors to refer to their product with either a $50 flat fee, or a percentage of sales. The trio would also repackage oral medications in brand new packaging and send them directly to the doctors they were working with so the physicians could dole out within their offices. The report lists that 22 doctors were involved, but would not provide names.
Considering that more than 48% of Americans have used at least one prescription drug within the past 30 days, this workers compensation ring really shows how vulnerable patients can be when it comes to trusting their medication provider.
As reported on Business Insurance, California Insurance Commissioner Dave Jones really drove home the audacity of the entire situation. In a statement, he said,
“The Kings and their co-conspirators played with patients’ lives, buying and selling them for profit without regard to patient safety.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 California Department of Insurance was responsible for the investigation, with help from the FBI, the Orange County District Attorney’s Office Bureau of Investigation, and the National Insurance Crime Bureau. For the settlement, about $23.2 million was paid from the Kings to defendants, and a full $40 million was given to insurance companies.
There is no word yet on jail time for either Tonya or Christopher King.