Several years ago, Monterey County Managing Deputy District Attorney Ed Hazel obtained grant funding from the California Department of Insurance for the DA’s office to create a Disability and Healthcare Fraud Unit to combat this specialized criminal issue. The unit pursues cases involving billing fraud, false disability claims, embezzlement, identity theft to secure healthcare benefits, prescription fraud, inflated or falsified pharmacy billing, outpatient surgery center fraud, and more.
According to the report in the Californian, some of the most common cases that the unit handles involve pharmacy fraud and identity theft in which someone will go to a hospital and pretend to be someone else in order to get treatment or a prescription under the other person’s name. This can create expensive problems for the actual person whose insurance is billed and even potentially dangerous issues as medical problems are recorded for a person when they don’t apply to them in reality.
“Identity theft has the clearest example where the real danger lies,” Hazel said. “It could lead to somebody being diagnosed with something that they don’t have. It could lead to a misdiagnosis.”
In July 2014, police officers responded to the Community Hospital of the Monterey Peninsula after a doctor noticed that a person seeking emergency care had been treated before under a different name. The man, Julian Rosario, continued to ask for Vicodin and eventually admitted to using a false name to receive treatment and avoid paying the hospital bill that included charges totaling $16,829.
Two weeks later, the same doctor recognized Rosario again and called police. After further investigation, it was found that Rosario had used pharmacy fraud and identity theft to receive treatments totaling $73,653. In the end, he pleaded guilty to six felonies and three misdemeanors and was sentenced to five years of probation in a plea deal.
Monterey County District Attorney Dean D. Flippo selected Deputy District Attorney Amy Patterson as the prosecutor for the unit, and for the past three years, Patterson has prosecuted 28 cases related to healthcare fraud, many of which are fairly complex and time-consuming.
The unit is now involved with its biggest case so far with Dr. Steven Mangar, who has been charged with 37 felonies related to healthcare fraud and unlawful prescriptions. Mangar’s office manager Maria “Aloha” Eclavea also faces 23 felonies related to the alleged health insurance fraud scheme. Their preliminary hearing is scheduled for August. That case alone involved about two years of investigation as well as the review of tens of thousands of pieces of evidence.
Lengthy investigation is often necessary “to grasp the intricacies of the fraud that may happen,” Patterson said, and as such, the unit may only prosecute one or two of the larger cases each year. “Sometimes we have to triage to decide how to do the most with our resources,” Hazel added, and if the problem becomes greater than the unit can handle, additional investigators may be brought in.