Three Orange County residents allegedly defrauded insurers by submitting bills for more than $50 million for medically unnecessary procedures, federal prosecutors said Wednesday in a 15-count indictment.
Charged were Vi Nguyen, 31, of Placentia (10 counts of mail fraud); Theresa Fisher, 44, of Tustin (five counts of mail fraud); and Lindsay Hargraves, 30, of San Pedro (two counts of mail fraud). Nguyen and Fisher were “consultants,” Hargraves a marketer. All three were arrested on July 1 before the criminal complaint was unsealed. They were all released on bond. They are to be arraigned on July 28.
Prosecutors claim the defendants used marketers to lure patients to a surgery center in Orange, known at various times as Empire Surgical Center, Vista Surgical Center and Princess Cosmetic Surgery. These were different business names for the same surgery center, consisting of one consultation office and one surgical suite, located at 1310 W. Stewart Drive, Suites 309 and 310, Orange, California. “The marketers told patients that they could use their union or PPO health insurance plans to pay for cosmetic surgeries, which are generally not covered by insurance,” the US. Attorney’s Office said in a statement announcing the indictment.
At the center, prosecutors said, the patients were told they could get free or discounted cosmetic surgeries if they submitted to “multiple, medically unnecessary procedures that would be billed to their union or PPO health care benefit program.” The health care programs were funded by the International Longshore and Warehouse Union and Pacific Maritime Association Welfare Plan as well as private programs such as Anthem Blue Cross Blue Shield and Horizon Blue Cross and Blue Shield of New Jersey. The plans generally did not cover cosmetic surgery.
The unnecessary procedures typical were endoscopies, colonoscopies and/or cystoscopies. The plastic surgeries included tummy tucks, falsely billed as hernia repairs; nose jobs, falsely billed as deviated septum repairs; breast surgeries and liposuction, prosecutors said. Empire, Vista, or Princess also allegedly billed union and PPO health care benefit programs for procedures that never were performed on patients.