San Jose woman pleads guilty to conspiracy to commit health care fraud

Gurinder Mand pleaded guilty in federal court in San Jose on Dec. 12, 2012, to conspiracy to commit health care fraud. The plea was announced by United States Attorney Melinda Haag from the Northern District of California.

In pleading guilty, Mand admitted she knowingly and willfully conspired with the former owner of EZ Step pharmacy and others to submit false and fraudulent claims to health care benefit programs, including Medicare, Medi-Cal, and private insurance companies.

According to a press release, the false and fraudulent claims included

(1) seeking reimbursement for claims without prescriptions, and by fabricating prescriptions and forging signatures of physicians on prescriptions; and (2) seeking reimbursement for the cost of licensed durable medical equipment (DME) and related prescription medications, benefits, items, and services, including by fabricating DME authorizations, certificates of medical necessity, and related documents, and forging the signatures of physicians and other authorized health care providers of beneficiaries on these documents.

Mand, 29, of San Jose, had been indicted by a federal Grand Jury on June 30, 2011. She is scheduled to be sentenced April 3, 2013, before United States District Court Judge Lucy H. Koh in San Jose.

Mand’s former employer at EZ Step, Edward G. Kluj, had also been indicted in this case, but died in August during the pendency of the case and the charges were accordingly dismissed without prejudice.

I posted this case here as a reminder to all of us – myself included – that we should check explanation of benefits (EOB) statements when they come in the mail to ensure that no one is using our policy number for prescription or DME fraud. While we may not be ultimately responsible for any fraudulent bills, having incorrect information in our medical records can be dangerous. In this case, and I presume many others, the insurance companies handle it internally when they become aware of fraud – notifying their insured and adjusting their records. But we may become aware of fraud before they do and so we need to take some responsibility to keep our own medical records uncontaminated.

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