Gerson Clinic Fraud by Corinthian ..... Cancer Conspiracies Debate Forum
Date: 7/26/2007 4:12:50 PM ( 17 y ago)
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By Penni Crabtree and Sandra Dibble
UNION-TRIBUNE STAFF WRITERS
February 24, 2002
The insurance claim read like a tourist’s nightmare.
Kathy Bash, an Oregon homemaker vacationing in Mexico, became violently ill after eating shrimp at a Tijuana restaurant. Her face swelled. Her breathing grew ragged. Itchy, scarlet lesions covered her chest, neck and face.
According to the claim, Bash was taken to the emergency room at Hospital Meridien, an alternative clinic in Tijuana controlled by Bonita businessman Scott Norby. The bill submitted to Bash’s U.S. insurance company was $900 for the potentially life-saving treatment.
There was one big problem: None of it was true.
Bash wasn’t in Tijuana as a tourist; she had booked her stay at the alternative clinic days in advance. She never ate shrimp, never had a medical emergency — the clinic didn’t even have an emergency room.
And Bash didn’t know about the bogus claim until her insurer contacted her months later.
In the lucrative world of Tijuana’s alternative clinics, insurance fraud often flourishes alongside unproven therapies.
U.S. insurance companies generally don’t reimburse for nonemergency medical care outside the country and rarely, if ever, pay for unproven experimental treatments. So some clinics file false claims through third-party insurance billers that they hire or set up in San Diego County and other border communities, investigators say.
The claims often disguise the fact that the treatments are performed outside the United States. Some list medical services that were never given, while others camouflage unproven therapies as chemotherapy or other approved treatments.
“They bill from the United States and try to collect in American dollars at grossly inflated charges,” said Louis Lovato, a fraud investigator for Blue Shield of California. “It’s a scam.”
Many insurance companies pay bogus bills because they can’t or don’t want to go through the cat-and-mouse game of investigating claims on the other side of the border. Others are simply hoodwinked.
“The clinics are willing to a certain degree to either falsify records or provide very little information so an insurer can’t tell what is going on,” said Susie Beetham, a fraud investigator with Indianapolis-based Intercontinental Corp., which administers U.S. medical claims for overseas insurance companies.
“Because insurers are under a lot of pressure to pay claims quickly, that also works to the benefit of charlatans.”
Scott Norby, president of the Tijuana clinic where Kathy Bash was treated, is among the few clinic operators to land in a U.S. courtroom over billing issues. Norby declined to be interviewed by the Union-Tribune, referring questions instead to his attorney, Knut Johnson.
Johnson said Norby believed it was OK to bill medical services as urgent or emergency care because many of his patients were desperately ill. He said such billing practices appear to be common among Tijuana alternative clinics.
“I get the sense that (Norby) is not unusual in what he does,” Johnson said. “He believed that because everyone else was doing it that it was not fraudulent.”
Norby and his partner, Harlan Dismuke, founded Hospital Meridien in October 1995. The clinic offered alternative treatments, including the Gerson therapy, a diet of organic juices, coffee enemas, supplements and enzymes.
Like most Tijuana clinics, Hospital Meridien required patients to pay upfront for their stays. But Norby also filed insurance claims through billing companies he established north of the border, including Meridian Health Systems, North American Metabolics and Principle Medical Management.
Bash checked into the clinic in December 1997, hoping the Gerson therapy would relieve her chronic allergies. She paid for her stay, and was surprised when Norby told her he would file claims seeking reimbursement from her insurer.
“I told Norby that I thought it wasn’t reimbursable, and his comment was, ‘Well, sometimes it’s the way you phrase things,’ ” Bash said. “And I thought, ‘OK, I don’t know the medical language for these things,’ but his comment did strike me as odd.”
Bash said she was shocked to learn later from her insurance company how the claim was worded — with its account of an allergic reaction to shrimp and emergency treatment. She said she gave her insurer her version of her stay, and the claim was rejected.
Fraud investigators said claims from Norby’s billing companies did not mention alternative therapies and usually implied that the patient had been admitted for emergency treatment.
“Quite frankly, it was just blatant, out-and-out fraud,” said Edward P. Allard III, an assistant U.S. attorney who prosecuted the Norby case.
Norby might never have been caught if he hadn’t decided to oust his partner.
On July 4, 1996, Norby walked into Hospital Meridien with his Mexican attorney and 10 armed guards and ordered Dismuke to leave and never return, according to court records. Dismuke fled, fearing for his life, the records indicate.
A few days later, Dismuke paid a surprise visit of his own. He went to Norby’s billing service, then in National City, and walked out with billing documents. He turned them over to a private investigator and ultimately to a lawyer, who tipped off the FBI, Allard said.
Investigators gathered evidence that Norby’s companies had allegedly filed 273 fraudulent insurance claims seeking $3.8 million. Unwitting insurers paid $626,000 of that amount.
Norby was convicted in San Diego federal court of 24 counts of mail fraud. In August, he was sentenced to 57 months in prison but is free on bail while he awaits an appeal.<< Return to the standard message view
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