A press release from the U.S. Attorney’s Office:
SUBURBAN CHIROPRACTOR SENTENCED TO 6½ YEARS IN PRISON FOR DEFRAUDING BLUE CROSS OF NEARLY $5.9 MILLION IN FALSE CLAIMS
CHICAGO — A chiropractor who partly owned six suburban clinics was sentenced today to 6½ years in federal prison for intending to defraud a private health insurance company of nearly $5.9 million and causing an actual loss of more than $2 million by submitting false claims for certain services that were not medically necessary or were not provided to patients.
The defendant, BRADLEY MATTSON, pleaded guilty in September to one count of health care fraud, admitting that he engaged in a 10-year scheme to defraud Blue Cross and Blue Shield of Illinois through all six clinics that he owned in combination with two co-defendants.
Mattson, 51, of Lake Forest, was ordered to begin serving his sentence on Jan. 25, 2013, by U.S. District Judge Ronald Guzman, who also ordered Mattson to pay restitution totaling $2,097,031.
“This scheme required extensive efforts.” Judge Guzman said.
“Frauds like this all across the country are jacking-up the price of insurance,” he said, adding that Mattson showed “no sensitivity to his patients,” and “put many of them through unnecessary stress.”
Between 1999 and 2009, Mattson co-owned and operated
- Hawthorn Physical Medicine
- Woodfield Physical Medicine
- Stratford Physical Medicine
- Algonquin Physical Medicine
- Northshore Physical Medicine
- Cumberland Physical Medicine
in combination with co-defendants Steven Paul and Neelesh Patel, both chiropractors.
According to his guilty plea and court records, Mattson directed that patients receive an initial x-ray and a pre-set schedule of clinic visits for a period of six months, without regard to the medical necessity.
In addition, he ordered that the clinics’ staff order MRI exams and neurological diagnostic testing performed by others without regard to necessity.
Overall, Mattson directed billings to Blue Cross Blue Shield totaling $5,891,848 for medically unnecessary tests or physical therapy services that were not provided, and his clinics collected $2,097,031 in reimbursement from the insurance company.
During the investigation, an undercover FBI agent visited the Hawthorn clinic in 2008 for treatment of a lower back strain.
Mattson diagnosed the agent with a pinched nerve and put him a preset treatment plan that began with daily visits for two weeks.
Mattson rendered his diagnosis despite the opinion of the clinic’s medical doctor and a physical therapist that the agent did not have a pinched nerve but rather a pulled muscle.
Paul, 41, of Northbrook, is awaiting sentencing after also pleading guilty in September to one count of health care fraud, while the charges against Patel, 37, of Glenview remain pending.
The government was represented by Assistant U.S. Attorney Renai S. Rodney.
The sentence was announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Thomas R. Trautmann, Acting Special- Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor Office of Inspector General in Chicago.