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Laguna Niguel Doctor Indicted in Billing Scam : Fraud: Federal grand jury accuses him of seeking more than $7 million in phony claims to insurers from 14 medical clinics.

TIMES STAFF WRITERS

A federal grand jury in Los Angeles on Wednesday indicted a Laguna Niguel doctor on 42 counts of mail fraud, alleging he schemed to bill insurance companies for more than $7 million in phony medical claims, the U.S. attorney’s office said.

Dr. Ameer M. Dixit was arrested at his Laguna Niguel home Wednesday evening by agents from the U.S. Postal Service and the California Department of Insurance Fraud, said Postal Inspector William Evans.

Dixit was placed in federal jail in Los Angeles and could not be reached for comment Wednesday evening. A 55-year-old immigrant from Katmandu, Nepal, Dixit came to the United States in 1969, according to the indictment.

Dixit was originally charged with mail fraud in 1988 and pleaded not guilty in that case. Federal prosecutors voluntarily withdrew the charge in order to broaden and continue their investigation, which includes other unindicted co-conspirators, Assistant U.S. Atty. Lee Michaelson said.

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The indictment, a product of a three-year probe, alleges that Dixit used his position at 14 medical clinics in Tustin, Santa Ana, Torrance, Oceanside, Vista, Escondido and San Diego to generate the phony claims. At several of these clinics, Dixit was employed as a staff physician or medical director.

Dixit and his associates drummed up customers through telephone solicitations, promising members of the public that they could come to the clinics for a comprehensive physical exam using “state of the art” diagnostics at little or no charge, the indictment alleges.

When the patients arrived at the clinic, they were put through a battery of tests, sometimes running up thousands of dollars worth of medical bills even before they saw a doctor, the indictment alleges.

Dixit and his associates would then submit phony claims to the insurance companies, saying that the patients were ill or had medical conditions that justified the procedures, the indictment alleges.

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“This is $7 million worth of fraud,” Michaelson said. “Here is a doctor with all of these people under his medical supervision and there is no basis for any of his claims.”

Among the tests performed were blood, cell and urine analyses, electrocardiograms, echocardiograms, cardiac stress tests, pulmonary function tests, abdominal ultrasounds and hearing and vision tests, according to the indictment.

“These were very sophisticated tests that were in excess of what was considered normal” for a checkup, Evans said.

Dixit and associates then altered the patients’ medical records and wrote down diagnoses which they knew would make the insurance companies more likely to pay the claims, the indictment alleges.

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Patients were not required to pay the clinic, according to the indictment, but in some cases they were asked to make a “donation” to cover the cost of their medical insurance policies’ deductibles or co-payments.

Most medical plans do not cover preventive physical exams, Michaelson said.

Evans said authorities were tipped to the alleged fraud after a number of insurance companies and patients complained that the tests were out of the ordinary and that the bills appeared to be inflated.

The scheme generated $7 million in phony bills between late 1986 and July, 1988, according to the indictment.

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One patient generated $5,887 in medical bills and another generated $7,829 from five different claim submissions on different dates, according to the indictment.

Michaelson said the investigation is continuing and charges are anticipated against Dixit’s co-conspirators.

The clinics named in the indictment are: Tustin Multispecialty Medical Center, Hospital Outpatients Medical Diagnostics Inc., and W. Medical Group, all in Tustin; K Medical Group Inc. in Torrance; Bristol Medical Diagnostics Services in Santa Ana; Oceanside Multi-Specialty Medical Clinic, and North County Medical Center in Oceanside; Central County Medical Services in Vista; Escondido Medical Center, Central County Medical Services Inc., and Physicians Care Medical Services, all in Escondido; and Palm Medical Group, Oceanview Medical Outpatient Center, and W. Medical Group Inc., all in San Diego.


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