A woman who was a "capper"--one who illegally recruits healthy patients to undergo unnecessary and often dangerous surgeries so medical practices can earn health insurance payments--was sentenced today to a year in jail for her role in what prosecutors call "the largest medical fraud prosecution in the nation."
And 60-year-old Pancha Keophimone still faces a restitution hearing next year, when she will likely have to pay back ill-gotten gains from the $154 million scam that recruited thousands of phony patients from across the country.
Keophimone, who worked at the since-closed Unity Outpatient Surgery Center in Buena Park, pleaded guilty in August to a court offer of 56 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million.
The Orange County District Attorney's office (OCDA) reports that Keophimone was technically sentenced to 12 years in state prison, but under the terms of her plea deal that was stayed pending completion of five years formal probation. Her restitution hearing is scheduled for May 18, 2012.
Keophimphone personally recruited 118 patients from 17 different states for 297 surgical procedures. This resulted in more than $8 million in billings to insurance companies for unnecessary surgical procedures.
Unity, whose cappers recruited a total of 2,841 healthy people, targeted businesses in 39 states with PPO insurance plans. The company transported the patients to Buena Park, scheduled the surgeries (usually on weekends) and coached the healthy on what to say to avoid raising suspicions. Patients were paid in cash or credits for cosmetic surgery after the procedures.
Nineteen defendants were originally charged and 13 were indicted in June 2008 by the Orange County Grand Jury, which examined 1,054 exhibits and heard testimony from 56 witnesses over 28 days. The indicted include an attorney, accountant, three doctors and other cappers. Among them are:
- Surgeon Dr. William Wilson Hampton, Jr., 56, of Seal Beach, who pleaded guilty in May 2009 to 47 felony counts including conspiracy, insurance fraud, and capping and was sentenced to 16 years in state prison.
- Doctor Michael Chan, 65, of Cerritos, who pleaded guilty in August to 40 felony counts including conspiracy to commit insurance fraud, insurance fraud, aiding and abetting capping with white collar crime sentencing enhancements. Unity's formed medical director faces a sentence ranging from probation up to 28 years in state prison at his March 9. 2012, sentencing hearing in Santa Ana.
- Capper Sue Nanda, 43, of Costa Mesa, who pleaded guilty in February 2009 to 22 felony counts including conspiracy, capping, grand theft, filing false tax returns, failing to file tax returns, and making false and fraudulent statements. She was sentenced the following August to 10 years in state prison and ordered to pay more than $500,000 in restitution for personal and corporate back taxes.
- Capper Maria DeJesus Licea Rosales, 44, pleaded guilty in August 2009 to 96 felony counts including conspiracy, capping, insurance fraud, grand theft, filing fraudulent tax returns, and sentencing enhancements for white collar crime and loss over $2.5 million. She was sentenced to eight years in state prison.
- Capper Olga Lilia Toscano, 41, pleaded guilty in August 2009 to 98 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. She was sentenced to eight years in state prison.
- Capper Ngoc Huynh, 51, pleaded guilty in August to 56 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, filing a false income tax return, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. He faces a maximum of 45 years and eight months in state prison at his Jan. 6, 2012, sentencing in Santa Ana. Capper Thuy Huynh, 53, is also scheduled to be sentenced there that morning.
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Six defendants pleaded guilty prior to the indictment and have been sentenced.
Unity administrators Tam Vu Pham, 46, Huong Ngo, 45, and Lan Nguyen, 55, pleaded guilty to recruiting doctors and cappers for the scheme. Pham, the primary perpetrator, was sentenced to 12 years in state prison.
Yet to be tried are Roy Dickson, 63, and Andrew Harnen, 57, who are scheduled to go before a jury on Dec. 12 in Santa Ana. Mario Rosenberg, 64, faces a pre-trial hearing on Jan. 13, 2012.
The case was jointly investigated by the California Department of Insurance and Orange County District Attorney's Office with assistance from the California Franchise Tax Board.