STAMFORD, Conn. -- A Stamford chiropractor was sentenced Tuesday to three years of probation for his role in a health-care insurance fraud scheme, U.S. Attorney for Connecticut Deirdre Daly said in a statement.
George U. DeCarvalho, 57, of Stamford and Jennifer Lynne, 41, of Milford were sentenced by U.S. District Judge Stefan R. Underhill in Bridgeport.
In addition to his probation, DeCarvalho, must perform 90 hours of community service. Lynne was sentenced to three years of probation, the first six months of which she must serve in home confinement with electronic monitoring.
The convictions stem from “Operation Running Man,” a 14-month undercover fraud investigation headed by the FBI. The investigation found that Joseph P. Haddad, a Bridgeport-based personal injury attorney, conspired with chiropractors and others to defraud several insurance companies by exaggerating the auto accident injuries of his clients, and the cost of their medical care, to justify larger monetary settlements with the insurance companies, the statement said.
As part of the scheme, the co-conspirators fabricated medical records, prescribed unnecessary pain medication, performed unnecessary chiropractic treatment, ordered and billed for diagnostic tests of questionable medical value, and overstated injuries or permanent partial disabilities that were allegedly caused by the accidents.
According to the statement, DeCarvalho and Francisco R. Carbone shared office space in Bridgeport from January 2004 to November 2005. After Carbone’s medical license was revoked in March 2005, DeCarvalho continued to treat certain patients knowing that payments for his services were coming from insurance settlements based, in part, on the purported treatment provided by Carbone.
In addition, in May 2007, DeCarvalho was involved in an auto accident in which the other driver was liable. He contacted Carbone to fabricate medical records to show that he had suffered injuries and had received medical treatment. DeCarvalho indicated that Carbone could bill carriers for treatment under his automobile MedPay insurance. In October 2007, Carbone fabricated the medical records and submitted claims to MedPay for reimbursement totaling $6,000. Relying on the false medical bills, DeCarvalho settled the accident claim for an additional $4,500.
On June 29, 2012, DeCarvalho pleaded guilty to one count of conspiracy to commit health care fraud.
In her case, Lynne and Jennifer Netter are licensed chiropractors who worked for Dr. Marc Kirshner, who owned and operated two chiropractor offices in Bridgeport and one in Stamford. Between December 2006 and February 2010, Health First chiropractors performed unnecessary chiropractic treatments on Haddad’s auto-accident clients. The chiropractic practice prepared false reports, which were then provided to the victim's insurance carriers.
More than 10 insurance carriers lost at least $1.7 million as a result of this fraud scheme. The loss directly attributable to Lynne's dealing with Haddad clients is $117,251. Underhill ordered Lynne to pay restitution in that amount.
On March 15, 2012, Lynne pleaded guilty to one count of conspiracy to make false statements relating to health care matters.
Haddad, Carbone, Kirshner, Netter, and Dr. James Marshall Jr. have each pleaded guilty to charges stemming from this scheme. They await sentencing.