District Attorney aims to curb insurance fraud

“The key for the prosecutors who are successful in this unit is attention to detail,” he said. “It takes a fine eye to do it.”

For the last 25 years or so, Wagstaffe’s office has received support from the California Department of Insurance to investigate instances of possible insurance fraud, which he said can range from fraudulent claims for workers’ compensation benefits to cases of health care or dental professionals billing insurance companies for work that either wasn’t done or didn’t need to be done.

He said the most recent grant from the department in the amount of $57,779 allowed his office to devote two inspectors to the investigation into the Daly City chiropractic practices of Benjamin Darrow, who has pleaded not guilty to multiple charges of insurance fraud and unlawful charging for laboratory services for alleged offenses dating from 2012 to 2015.

Accused of performing a food allergy test that was not covered by insurance companies on more than 250 patients, the 49-year-old El Granada resident is believed to have disguised the fact that he was performing the allergy test when billing insurance companies an estimated $3,000 per test, collecting more than $790,000 in improper insurance payouts, according to Wagstaffe.

Darrow is also said to have claimed patients’ blood samples were being sent to an outside lab while he was performing the blood work at his own practice and was not honest about the approximately $600 he paid for each test, according to Wagstaffe.

Out of custody on a $350,000 bail bond, Darrow is slated to appear for jury trial May 6. Given the number of patients and sum of the total funds Darrow is believed to have taken from insurance companies, Wagstaffe said he wanted to ensure his office had the resources to devote to a case affecting so many individuals.

“We’re concerned for the community,” he said. “You can imagine what improper chiropractic work could do to a person, it could be devastating.”

Wagstaffe said another example of the types of cases his office has prosecuted recently involved a 44-year-old former San Mateo County sheriff’s deputy who was recorded running in a Spartan Race after he said he injured his left shoulder during defensive tactics training in 2016. Edmundo Rocha was offered workers’ compensation benefits and was eventually put on total temporary disability by the San Mateo County Sheriff’s Office in January of 2017, some nine days before he performed many of the obstacles that appeared to be in violation of his restrictions during the Spartan Race in San Jose.

Rocha, who had been placed on administrative leave, resigned from his post shortly after he entered a no contest plea in January to misdemeanor workers’ compensation fraud, was sentenced to 10 days in county jail and ordered to pay $5,000 in restitution to San Mateo County. Former Daly City Councilwoman Maggie Gomez was sentenced to six months in county jail and stepped down from her seat on the council in 2011 after she was caught on video exercising at the gym more than 100 times during a period in which she was claiming to be too injured to work at the Seton Medical Center.

Wagstaffe said the Insurance Fraud Unit may get a lead on a case from insurance companies or patients who report suspicious billing patterns. He said the unit may work with police departments, the California Department of Consumer Affairs or the Medical Board of California as well as investigators with the Department of Insurance Fraud to explore possible insurance fraud cases.

According to California Insurance Commissioner Ricardo Lara’s office, insurance fraud takes many forms and is a multi-billion dollar drain on California’s economy resulting in higher insurance premiums for California businesses and consumers. Citing the FBI, Lara’s office noted the total cost of insurance fraud nationwide — excluding health insurance fraud — is estimated to be more than $40 billion annually and cost the average U.S. family between $400 and $700 a year in increased premiums.

Acknowledging insurance fraud is not a victimless crime, Lara’s office noted all residents pay for these types of crimes through higher premiums when insurers pass their losses onto customers.

“Our seniors, people living in poverty and immigrant communities are targets of con artists and scams,” Lara said in a statement. “Our department is aggressive in confronting insurance fraud that affects these and other vulnerable communities in California.”

anna@smdailyjournal.com

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