For release on May 28, 2013
Denise Raabe, Deputy District Attorney
Insurance Fraud Unit
TWO BAY AREA CHIROPRACTORS CHARGED WITH MEDICAL BILLING INSURANCE FRAUD
Two Sunnyvale chiropractors face insurance fraud charges after an investigation showed that one of them provided chiropractic treatments to her own family while another pretended to be the provider – an illegal scheme set up to get thousands of dollars in insurance money.
Dr. Wendy Lanser, D.C., 47, of Los Altos, and Dr. Lisa Shaw-O’Conner, D.C., 33 of Fremont, are charged with multiple felonies involving medical billing insurance fraud. They were arrested on May 24, 2013. They are scheduled to be arraigned at 1:30 p.m. on June 11, 2013.
If convicted of all counts Lanser faces a maximum of 19 years and 8 months in prison and Shaw-O’Conner, a maximum of 13 years. They would be ordered to pay full restitution.
“It hurts everyone when a medical provider fraudulently submits medical claims,” Deputy District Attorney Denise Raabe, of the Health Insurance Fraud Unit, said. “The cost of provider fraud is ultimately passed onto the insurance consumer.”
The scheme was uncovered by a joint investigation by the California Department of Insurance, Silicon Valley Regional Office, and the Santa Clara County District Attorney’s Office, Bureau of Investigations.
Lanser owns Lanser Chiropractic Inc., located in Sunnyvale. Shaw-O’Conner is a part-time independent contractor working out of the office. It is alleged that over several years Lanser provided weekly chiropractic treatments for her husband and two children. She then submitted insurance claim forms for payment for the treatments she provided to her family using the name and billing identification number in the ‘servicing physician’ section of the claim form of an unwitting employee chiropractor. This is medical billing fraud because the name of the servicing physician on the form is not the physician that provided the treatment. In addition, the insurance policy that covers Lanser and her family, specifically excludes from coverage any medical treatment provided by a family member. This is a common exclusion found in the majority of medical insurance policies and reflects the cost controlling and ethical understanding that an insurance company should not pay for services that are provided gratuitously between family members.
In more recent cases, Shaw-O’Conner allegedly knowingly signed insurance claim forms as the ‘servicing physician’ for Lanser’s family members, when she did not provide the chiropractic services to the family members.