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Thom Mrozek (213) 894-6947 |
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Release No. 07-167
December 19, 2007
TWO FOUND GUILTY IN $34 MILLION FRAUD SCHEME INVOLVING ORANGE COUNTY OUTPATIENT SURGERY CENTER
A federal jury today convicted two women for their roles in a $34 million scheme to defraud health insurance companies by billing for unnecessary medical procedures performed at Santa Ana’s Millennium Outpatient Surgery Center (MOSC).
Olga Lilia Toscano, 37, of Irvine, was convicted of conspiracy and four counts of mail fraud, while co-defendant Maria Licea Rosales, 39, of Santa Ana, was convicted of conspiracy and one count of mail fraud. Both women were marketers for MOSC.
The evidence presented during a five-week trial showed that Toscano and Rosales offered money and discounted cosmetic surgery to people who had private health insurance coverage in order to persuade them to undergo unnecessary and overpriced procedures at MOSC. The procedures included colonoscopies, endoscopies and laparoscopies. Toscano and Rosales directed the people they recruited to describe false and exaggerated symptoms to treating physicians at MOSC for the purpose of obtaining authorization and payment from private health insurers for the unnecessary procedures. MOSC then submitted inflated claims to the insurance companies. For example, MOSC routinely submitted $10,000 bills for colonoscopies, when that procedure normally costs no more than $3,000. The scheme ran from the beginning of 2000 through March 2004.
Toscano and Rosales are scheduled to be sentenced by United States District Judge Alicemarie H. Stotler on March 28. The maximum penalty under federal law for each count of mail fraud is 20 years in federal prison, and the maximum penalty for conspiracy is five years in prison.
The jury that convicted Toscano and Rosales also acquitted them on a total of five counts and was unable to reach a verdict on another six counts.
The owner and operator of MOSC – Perry Pham, 43, of Mission Viejo – previously pleaded guilty to one count of mail fraud, and MOSC itself previously pleaded guilty to one count of money laundering. Esmeralda Ortiz Tello, 34, of Anaheim, who also recruited patients for MOSC, previously pleaded guilty to misprision of a felony. These three defendants are scheduled to be sentenced early next year.
The case involving MOSC is part of the Outpatient Surgery Center Fraud Enforcement Initiative, a joint effort involving the Federal Bureau of Investigation, the United States Postal Inspection Service, IRS-Criminal Investigation, the Office of Personnel Management and the United States Department of Justice.
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Release No. 07-167
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