Glen Justice, OC Cancer Doctor Who Devised $1 Million Insurance Fraud Scam, 'Couldn't Say No' To Patients
A doctor charged with submitting bills for up to $1 million worth of cancer medications--medications that were never provided to patients--will be suspended for a year after he gets out of jail, then placed on 10 years of probation, the California Medical Board has announced.
Glen Justice ran Pacific Coast Hematology/Oncology Medical Group in Fountain Valley. According to a plea agreement, which he signed in 2010, the oncologist defrauded insurers including Medicare, Blue Shield and Blue Cross. He would bill the providers for injectable cancer medications, but patients never received them or they would receive less-expensive drugs, according to the agreement. Insurance companies lost $400,000 to $1 million.
In July 2011, Justice was sentenced to 18 months in federal prison and ordered to pay $1,004,689 in restitution.
According to legal documents, Justice stated that he committed these crimes because he could not afford to deliver care to patients. Insurance reimbursements were inadequate to fund the operations of his practice, he testified. At an administrative hearing, Justice explained that there were pressures on him and he "could not say no." He recalled how patients "kept coming in with no insurance" and how he "took care of a lot of people who were indigent." He stated that he "felt trapped and did not know how to [tell patients] 'I don't have your medicine because I cannot pay for it,' and stated that "the way to fix it was to fix the billing." He insisted that patient care was never compromised.
A clinical psychologist who treated Justice testified that Justice said he used "upcoding" (over-billing insurance providers by using codes for more serious medical conditions) and obtaining illegal reimbursements for medications not provided to keep his clinic running. The illegal funds also covered tens of thousands of dollars in financial support to Justice's adult sons. According to the psychologist, Justice suffered from depression and anxiety, and is now on medication. Prior to his conviction, Justice was active in cancer research, gave numerous lectures for the American Cancer Society and volunteered his time on medical missions to Haiti, Ukraine and Mexico, according to documents.
The California Medical Board has concluded that Justice has "accepted responsibility for his crimes and has made attempts to rectify his transgressions." Justice, who has not yet served his sentence, will be able to practice medicine after his year-long suspension, but will be prohibited from supervising physician assistants and engaging in solo practice.
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