Recruiter for bogus surgeries sentenced
An Orange County woman was sentenced to eight years in prison Tuesday for recruiting people for unnecessary surgeries as part of a multi-state, $154-million medical insurance fraud scheme.
Lilia Toscano, 41, pleaded guilty to 98 counts that included conspiracy, grand theft, tax evasion, insurance fraud and so-called capping, or recruiting patients for a fee, the Orange County district attorney’s office said.
Toscano enlisted more than 245 people, most of them from California, to take part in the bogus surgeries in exchange for money or low-cost cosmetic surgeries. Some of the unnecessary procedures included operations for “sweaty palms,” the district attorney said.
Farrah Emami, a spokeswoman for Orange County District Atty. Tony Rackauckas, said the victims in this case were the insurance companies and consumers.
“The ultimate victims in this case are the consumers,” she said. “They’re the ones who have to pay higher insurance rates” because the companies pass along some of their costs.
Insurance carriers were billed more than $10 million for surgeries and made payments in excess of $2.5 million for the patients recruited by Toscano, according to the district attorney. Toscano was paid $770,000.
In all, 19 people have been charged in the case, according to the indictment. They include an attorney, doctors and suspected cappers.
So far, six people have pleaded guilty. The remaining defendants are scheduled for trial in August at the Central Justice Center in Santa Ana.
Authorities said the cappers worked in 39 states, targeting business employees who were covered by insurance plans. In all, 2,841 people received surgeries as part of the scheme.
Toscano and the other cappers, authorities said, coached the patients about their “symptoms,” helped them fill out paperwork and set up the medical appointments.
The three doctors who were part of the scheme performed 1,037 medical procedures, some of them on members of the same families, the district attorney said.
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