Tag: fraud

 

Mira Mesa dentist sentenced to 6 years in custody for $866K insurance fraud scheme

A Mira Mesa dentist was sentenced Wednesday to six years in custody and ordered her to pay more than $405,000 in restitution for fraudulently billing 10 insurance companies for hundreds of root canals she did not perform, authorities said.

April Rose Ambrosio, 59, pleaded guilty earlier this year to three counts of insurance fraud as part of a four-year scheme in which she billed the insurance companies $866,700, according to prosecutors and the state insurance commissioner.

Authorities said she was paid $405,633 by the insurance companies. San Diego Superior Court Judge Daniel Goldstein ordered Ambrosio to pay back that money.

She was ordered to serve a split sentence, meaning she will spend three years in county jail and three years on mandatory supervision in the community. California law changed in 2011 to allow some non-violent offenders to serve their prison terms in jail — a situation often described in court as “local prison.”

In September 2019, a judge ordered Ambrosio to stop practicing dentistry. State records show that’s when her license, which was issued in 1990, was suspended.

Authorities said Ambrosio falsely claimed to have performed 800 root canals on 100 patients between 2014 and 2018, even though she lacked the specialized training required to perform root canals.

In some instances, the people she claimed to have performed root canals for had never set foot in her office. In another instance, she billed an insurance company $61,700 for 110 root canals, all of which she claimed to perform on a family of four over just a three-month period in 2016.

“Her deception involved billing for work on days her office was closed, or she was noted as being on vacation,” county prosecutors said in a news release. “In some instances, Ambrosio billed for root canals on non-existent or missing teeth, or she double billed for teeth she previously claimed to have performed root canals on.”

San Diego County District Attorney Summer Stephan said the way that Ambrosio “bilked the system” was “astounding.”

“Unfortunately, when insurance companies get ripped off, consumers ultimately pay the price through higher premiums,” Stephan said in a news release.

Ambrosio’s attorney, Kerry Armstrong, said his client “is extremely remorseful” and ready to begin her sentence next week.

“By all accounts, she was a fantastic dentist to her patients,” Armstrong wrote in an email Wednesday night. “And while she possibly will never get to practice dentistry again, she hopes to work in a field where she can help people once she serves her sentence and regains employment again.”

California Department of Insurance personnel investigated Ambrosio for more than two years and worked with the insurance fraud division of the District Attorney’s Office to prosecute the case.

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Ex-doctor whose patient killed Montgomery family in wreck sentenced to 7 years for fraud

A former doctor was recently sentenced to federal prison on fraud charges he incurred after a prescription patient of his high on medication fatally crashed into a family of four driving home from church in Conroe.

Rezik A. Saqer, 66, of Houston, was sentenced to seven years on Oct. 9 by Chief U.S. District Judge Lee H. Rosenthal of the Southern District of Texas. Rosenthal ordered Saqer to pay $5 million in restitution for fraudulently billing health care programs.

In early July 2019, Saqer pleaded guilty to conspiracy to commit health care fraud. Saqer, according to an Oct. 9 release from the U.S. Department of Justice, was a physician and anesthesiologist at Texas Pain Solutions and Integra Medical Clinic.


Saqer’s patient, Ronald Evan Cooper, 73, of Montgomery, was sentenced to 80 years in prison in May 2017 for intoxication manslaughter. Cooper fatally struck with his car Roland Sedlmeier, 49, Melinda Sedlmeier, 42, Harley, 6, and Sofie, 4, as the family departed Sunday church service Sept. 20, 2015 on Texas 105.

Evidence presented at Saqer’s sentencing showed he had patients submit to “unnecessary and dangerous” procedures and tests as performed by his unlicensed staff and then billed them to health care providers as if he had carried out the work, the District Attorney’s office stated.

Health care providers were fraudulently billed more than $14.6 million by Saquer, according to the DOJ press release.

Additionally, “Saqer’s scheme contributed to multiple overdose deaths,” read a statement from the DA’s Office.

Citing an interest in not conflicting with Saqer’s prosecution in federal court, the District Attorney’s Office dismissed six murder charges the former doctor was facing and a seventh felony charge. These seven charges resulted from the prosecution of Cooper, according to the DA’s office.

Between March 2014 and September 2015, five of Saqer’s patients allegedly died as a result of him furnishing them drugs knowing they were substance abusers. A sixth murder charge alleged a patient in 2011 died after Saqer had an unlicensed person furnish “nontherapeutic” drugs, according to a probable cause affidavit.

The other dismissed charge was for a first-degree organized criminal activity felony for allegedly billing insurance companies for services not rendered in the span of five years, the affidavit showed.

The charges for which Saqer was sentenced resulted from work on the case against him as led by Assistant DA Tamara Holland, along with the Texas Department of Insurance and the Conroe Police Department, the DA’s Office stated.

“I want to thank all of the many people who worked so hard to obtain this outcome. There were endless hours spent on this case by a significant number of investigators and prosecutors, all to ensure Dr. Saqer finally met justice for his dangerous scheme,” Holland said in a statement.

District Attorney Brett Ligon spoke on the impact the Sedlmeier crash had on his office.

“I am proud to have our office work in close cooperation with multiple state and federal agencies, to investigate a case that has affected our community

Dentist who stole $866K through insurance fraud gets 6 years in prison

SAN DIEGO (CNS) – A former Mira Mesa dentist who bilked insurance companies out of hundreds of thousands of dollars by submitting claims for procedures she never performed, including hundreds of supposed root canals, has been sentenced to six years in state prison, the San Diego County District Attorney’s Office announced Wednesday.

April Rose Ambrosio, 59, pleaded guilty to three counts of insurance fraud earlier this year for fraudulently billing insurance companies for $866,700, for which she received more than $400,000 from 10 insurance companies, according to prosecutors.

The DA’s Office said Ambrosio falsely claimed she performed 800 root canals on 100 patients, despite not having specialized training as an endodontist to perform such procedures.

Ambrosio was sentenced earlier this month, and in addition to a six-year prison term, was ordered to pay $405,633 in restitution. Her license to practice dentistry was also suspended last year, a few months after she was charged.

Prosecutors say the fraud occurred between 2014 and 2018.

During that time, Ambrosio billed for work she said occurred on days her office was closed and billed for more than 100 root canals during a three- month period, all of which were supposedly performed for a family of four, according to the DA’s Office. She also billed for root canals on teeth patients didn’t have or double billed for teeth she previously said she performed root canals on, the DA’s Office said.

“The way this defendant bilked the system is astounding,” District Attorney Summer Stephan said. “Unfortunately, when insurance companies get ripped off, consumers ultimately pay the price through higher premiums.”

Ambrosio’s case was investigated over the course of two years by the California Department of Insurance and the San Diego County District Attorney’s Office.

“This medical provider abused the trust placed in her by fraudulently billing for procedures she never performed and was never trained to perform,” California Insurance Commissioner Ricardo Lara said. “Her illegal actions cost California consumers through higher insurance premiums and erodes the trust consumers hold for honest providers in the dentistry field.”

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Mira Mesa Dentist Gets Six Years For Insurance Fraud

SAN DIEGO, CA — A former Mira Mesa dentist who bilked insurance companies out of hundreds of thousands of dollars by submitting claims for procedures she never performed, including hundreds of supposed root canals, has been sentenced to six years in state prison, the San Diego County District Attorney’s Office announced Wednesday.

April Rose Ambrosio, 59, pleaded guilty to three counts of insurance fraud earlier this year for fraudulently billing insurance companies for $866,700, for which she received more than $400,000 from 10 insurance companies, according to prosecutors.

The DA’s Office said Ambrosio falsely claimed she performed 800 root canals on 100 patients, despite not having specialized training as an endodontist to perform such procedures.

Ambrosio was sentenced earlier this month, and in addition to a six- year prison term, was ordered to pay $405,633 in restitution. Her license to practice dentistry was also suspended last year, a few months after she was charged.

Prosecutors say the fraud occurred between 2014 and 2018.

During that time, Ambrosio billed for work she said occurred on days her office was closed and billed for more than 100 root canals during a three- month period, all of which were supposedly performed for a family of four, according to the DA’s Office. She also billed for root canals on teeth patients didn’t have or double billed for teeth she previously said she performed root canals on, the DA’s Office said.

“The way this defendant bilked the system is astounding,” District Attorney Summer Stephan said. “Unfortunately, when insurance companies get ripped off, consumers ultimately pay the price through higher premiums.”

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