Insurance fraud charges will stand against a pain management physician and ASC owner in California for allegedly bilking a workers compensation insurer, according to court documents provided on Justia.
Four notes:
1. Sanjoy Banerjee, MD, founded Pacific Pain Care in Wildomar, Calif., in 2010 and established two other entities — Kensington Diagnostics and Rochester Imperial Surgical Center — at the same site in 2014.
2. Dr. Banerjee allegedly referred patients to the two entities and billed workers compensation insurer Berkshire Hathaway Homestate Companies for their services. Under Section 139.3 of California's labor code, "A physician who refers to or seeks consultation from an organization in which the physician has a financial interest shall disclose this interest to the patient or if the patient is a minor, to the patient's parents or legal guardian in writing at the time of the referral."
3. Perjury charges against Dr. Banerjee will be set aside, as the statute allows a "physician to render services to patients through separate legal entities, including entities in which the physician has a financial interest, provided that the services are rendered within the same 'physician's office' or the office of a group practice," according to the court.
4. The court concluded that the insurance fraud charges against Dr. Banerjee will stand, after evidence showed that he presented "false and fraudulent claims for healthcare benefits to [Berkshire Hathaway] through Kensington and Rochester, with the specific intent to defraud [Berkshire Hathaway]."