Doctor & interpreter charged with defrauding workers' comp insurers
The California pair allegedly billed insurers for translation services that were illegal or non-existent.
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A California doctor and an allegedly unqualified medical interpreter have been charged with conspiring to bilk insurance companies out of thousands of dollars by billing for translation services that were illegal or non-existent.
Related: $12 million workers’ comp fraud scheme busted in San Jose
The district attorney for the county of Santa Clara alleged that, in some cases, interpreter Gabriela Pacheco simply substituted her unqualified family members to do the translations, which are required by state law to be done by a certified interpreter. In other cases, Pacheco allegedly billed companies for patients with Latino surnames for which she had not done any work at all. Dr. Tariq Mirza helped organize the scam and received kickbacks, according to the charges.
Conspiracy to commit WC billing fraud; unlawful kickbacks
Dr. Mirza and Pacheco were charged with conspiracy to commit workers’ compensation billing fraud and unlawful kickbacks for patient referrals.
“There’s a reason you have to be certified to do these translations,” prosecutor Julie Sousa said. “Injured workers are entitled to a standard level of care — which includes qualified interpreters to translate everything from their surgery risks to medication instructions.”
Related: Texas attorney sentenced to prison for role in $26M workers’ comp fraud
Dr. Mirza is the owner of Ariba Healthcare Group Inc., providing medical and chiropractic treatment with offices in San Jose and the greater Bay Area. The clinics primarily treat patients in the workers’ compensation system. Pacheco is the owner of One World Interpreting Services, a San Jose company that provides Spanish translation services for medical providers.
Kickbacks total over $100,000
The district attorney said that an investigation revealed that Pacheco was billing over 100 insurance companies, claims administrators, and self-insured employers despite being unqualified under the California Code of Regulations. The district attorney requested assistance from the Franchise Tax Board (FTB) and said that an FTB agent examined thousands of records, which uncovered over $100,000 of kickbacks from Pacheco to Dr. Mirza through payments made to third parties.
According to prosecutors, in 2017, district attorney investigators discovered that Dr. Mirza had submitted written reports to at least six insurance companies falsely identifying Pacheco as a “licensed interpreter.” A search of Pacheco’s home business revealed over 1,000 patient files containing medical information, in violation of medical record privacy laws, prosecutors alleged.
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Steven A. Meyerowitz, Esq., (smeyerowitz@meyerowitzcommunications.com) is director of FC&S Legal, editor-in-chief of Insurance Coverage Law Report, and founder and president of Meyerowitz Communications Inc.