Feds Crack Down on Insurance Fraud Scheme

A Florida billing company’s owners set up an Ohio pain management ASC and defrauded insurers out of millions of dollars to fund a lavish lifestyle, say federal authorities.

Christopher Liva, his father Edward Liva, and Carolyn Via, who own the Boca Raton, Fla.-based Physicians Surgical Group and who operated the now-defunct Shaker Heights (Ohio) Surgical Center, have been charged with conspiracy, wire fraud, healthcare fraud and money laundering in the multi-million-dollar scheme.

The federal indictment also named PSG’s chief financial officer, Mark Fritz of Coral Springs, Fla.; chiropractors John Fortuna of Avon, Ohio, and Antony Simone of Cleveland, who practiced at the ASC; and anesthesiologist John Nickels, MD, of Highland Heights, Ohio, in the charges.

“This group bilked insurance companies through a series of false claims and diagnoses to get money, diamonds and expensive homes,” says U.S. Attorney Steven M. Dettelbach, in a statement.

According to authorities, between 2007 and 2010 the owners recruited chiropractors to perform manipulation under anesthesia, the experimental pain management procedure, at the ASC, offering them $4,000 kickbacks for each patient referred.

They then fabricated patient diagnoses, inflated billing claims to private insurers, “represented that procedures were performed by osteopathic and medical doctors when in reality they were performed by osteopathic doctors and chiropractors,” and did not collect patients’ co-pays and deductibles, says the statement.

In connection with the charges, prosecutors are seeking to seize cash assets as well as 2 Boca Raton properties, a wristwatch worth tens of thousands of dollars and a pair of 4.18-carat diamond earrings purchased with the conspiracy’s proceeds.

Calls seeking comment from the Physicians Surgical Group owners and Drs. Fortuna, Simone and Nickels were not immediately returned. In a published report, Drs. Fortuna and Nickels denied involvement in the billing scheme and Dr. Simone regretted his association with the group.

A spokesman for the U.S. Attorney’s Office for the Northern District of Ohio in Cleveland did not return a call seeking additional information.

David Bernard