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Federal Court Sentences Los Angeles Chiropractor After U.S. Department of Labor Uncovers Healthcare Fraud
LOS ANGELES, CA – After an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) and its Office of Inspector General, the U.S. District Court for the Central District of California has sentenced Darren Hines, a Los Angeles chiropractor, to three months of probation and 14 months of home detention, and ordered him to make $479,352 in restitution for defrauding a maritime union welfare plan.
The joint investigation found that from January 2017 through August 2018, Hines – owner of Advanced Alternative Health – engaged in a scheme to defraud the International Longshore and Warehouse Union-Pacific Maritime Association (ILWU-PMA) Welfare Plan by submitting approximately $500,000 in fraudulent claims for services not rendered and for services provided by unlicensed employees not qualified to perform them. Hines pleaded guilty in September 2019 to one count of healthcare fraud.
After his termination as an authorized chiropractic provider by the ILWU-PMA Welfare Plan, Hines established Advanced Alternative Health in his sister’s name and hired a licensed chiropractor to serve as the sole provider at the clinic. As the owner of the clinic, Hines then submitted claims to the plan for services provided by the licensed chiropractor, a violation of his termination as an authorized provider to the plan.
Hines also hired unlicensed massage therapists to provide massage therapy to plan members who visited the clinic and billed the ILWU-PMA Welfare Plan for massages not supervised by a licensed provider or determined to be medically necessary. Additionally, Hines would bill the plan for services under the name of the licensed chiropractor even though the chiropractor neither provided nor supervised the provision of such services, and even though the chiropractor never gave Hines authority to submit claims to the plan in his name for services he did not provide.
“Unfortunately, unsuspecting individuals were drawn into this scheme,” said Employee Benefits Security Administration Regional Director Crisanta Johnson, in Los Angeles, California. “EBSA will continue to work vigorously with our law enforcement partners to combat fraud involving health plans.”
“Darren Hines stole money set aside for union members’ health benefits by fraudulently billing for services that were being performed by unlicensed practitioners. We will continue to work with our law enforcement partners to protect the integrity of union health benefit plans,” said Quentin Heiden, Special Agent-in-Charge, Los Angeles Region, U.S. Department of Labor’s Office of Inspector General.
The U.S. Attorney’s Office for the Central District of California prosecuted the case.
Employers and workers can reach EBSA toll-free at 866-444-3272 for help with problems related to private sector retirement and health plans. Additional information can be found at http://www.dol.gov/ebsa
EBSA’s mission is to assure the security of the retirement, health and other workplace related benefits of America's workers and their families. EBSA accomplishes this mission by developing effective regulations; assisting and educating workers, plan sponsors, fiduciaries and service providers; and vigorously enforcing the law.
The OIG conducts criminal, civil and administrative investigations into alleged violations of federal laws relating to Department of Labor programs, operations and personnel. In addition, the OIG conducts criminal investigations to combat the influence of labor racketeering and organized crime in the nation’s labor unions. Such matters should be referred promptly to the OIG Hotline (https://www.oig.dol.gov/hotlinecontact.htm) or 1-800-347-3756.
The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.