Dr. Mario Rosenberg, a 73-year-old physician who lives in Beverly Hills, is the last of 19 defendants in a $154 million medical insurance fraud scheme dating back more than two decades – was sentenced Friday to three years of formal probation, 1,000 hours of community service and ordered to pay $2.9 million in restitution.
He is one of the doctors accused of performing more than 1,000 unneeded surgeries on healthy patients. Prosecutors alleged that 2,841 people across the country were recruited to undergo unnecessary and dangerous surgeries in exchange for access to lower cost cosmetic surgery. Authorities once described this as the largest medical fraud prosecution in the United States, dubbed the “Unity Outpatient Surgery Center scheme,” referring to the Unity Outpatient Surgery Center in Buena Park, California.
At the time, Rosenberg was on staff at Cedars-Sinai Medical Center and affiliated with Herbalife. He primarily performed colonoscopies and esophagogastroduodenoscopy (EGDs). Rosenberg was accused of performing 646 procedures on 554 patients, which resulted in the fraudulent billing to insurance companies of more than $9 million, for which Unity was paid more than $2.3 million. Of Rosenberg’s patients, 84 percent were referred by cappers who were also charged.
Rosenberg entered a no contest plea in the case on Jan. 24, 2014. Attorneys have been working since the no contest plea to assess the gastroenterologist’s assets and determine how much he should pay in restitution.
The Unity cappers, or recruiters, targeted employees from businesses in more than 32 states and covered by PPO insurance plans, as pre-approval from the insurance company would not be a requirement for surgery.
More than 1,600 employers were affected by employees who were involved in this scheme. The cappers arranged transportation for the patients, scheduled the surgeries, and coached the healthy patients on what to say. In exchange for undergoing surgery, the “patients” would receive a cash payment, usually between $300 and $1,000 per surgery, or credit toward a free or discounted cosmetic surgery.
Many of the surgeries were performed on Saturdays and Sundays by the doctors. Often, they operated on members of the same household on the same day. The doctors are accused of ignoring basic medical protocols such as: 1) patients receiving surgeries on consecutive days instead of while under one anesthesia; 2) doctors not meeting the patients prior to operating; 3) doctors not following up with patients after the procedure was completed; and 4) doctors not obtaining necessary medical information.
In a rare move, Fourth District Appellate Court Justice Thomas Goethals, who presided over the no contest plea and the trials and plea bargains of the other defendants, returned to Orange County Superior Court to hand down Rosenberg’s punishment.