Insurance Fraud Scheme Lands Chiropractor in Prison

April 16, 2021 | Margarita Christoforou | Fraud and Abuse | Litigation | Medicare and Medicaid

The U.S. Department of Justice (DOJ) announced on April 13 that James Spina, a licensed chiropractor and the unlawful operator of Dolson Avenue Medical, P.C. (DAM), was sentenced to nine years in prison and three years of post-release supervision. DAM, a multi-disciplinary medical practice in Middletown, New York, purported to provide a variety of pain management and rehabilitation services.

According to the indictment, Spina defrauded Medicare and other insurance providers through DAM and eight other corporations that operated out of the same address. Although the associated entities were purportedly separately owned by licensed individuals, in reality, Spina and a co-defendant were the true owners and operators of all of the corporations.

Spina drafted sham leases and marketing agreements between DAM and the other corporations and siphoned money from DAM through “rent” and “marketing fees.” Spina and his co-conspirators also submitted claims for medical services that were not rendered, double billed insurance providers, altered and fabricated medical records, impeded Medicare audits, and submitted claims for medically unnecessary services and procedures.

In addition to the lengthy prison sentence, Spina was ordered to pay almost $10 million in restitution and to forfeit another $9.1 million. The FBI, the U.S. Department of Health and Human Services’ Office of Inspector General, and local authorities assisted in the DOJ’s investigation.

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