A federal judge sentenced a member of the International Longshore and Warehouse Union or ILWU, Local 13, to 41 in prison for causing two medical clinics to bill the union’s health care plan for chiropractic services that were not provided or were not medically necessary.
David Gomez, 53, of San Pedro, submitted more than a quarter-million dollars in bills to the union’s health care plan for the chiropractic services, according to officials.
Gomez was convicted in October of 20 counts of mail fraud. Gomez has been in custody since a federal jury returned its guilty verdicts.
The ILWU represents dockworkers at the ports of Los Angeles and Long Beach. Members of the union receive benefits, including health care benefits, through the ILWU-Pacific Maritime Association Welfare Plan.
“By defrauding the health plan of his fellow union members, Gomez betrayed and abused the trust of the very people his clinics purported to serve. Though this case is a sobering reminder of the often shameless nature of fraud schemes, today’s sentence sends a stern warning to those who would line their pockets at the expense of health plan participants and sponsoring employers. The Office of Inspector General will continue to work with our law enforcement partners to investigate the theft of union benefit plan assets,” stated Abel Salinas, Special Agent-in-Charge of the Los Angeles Office, Office of Inspector General, U.S. Department of Labor.
According to the evidence, Gomez and his co-defendant, Sergio Amador, opened a clinic in Long Beach in 2009 that operated under the name Port Medical and provided medical and chiropractic care.
The next year, they opened a second clinic operating under the same name in San Pedro.
Gomez and Amador also created medical management companies that they used to receive funds generated by the medical clinics, which they then used to pay themselves and to pay incentives to ILWU members to use, and encourage other ILWU members, to use the Port Medical clinics.
These incentives were often paid as “sponsorships” of basketball or softball teams, with the understanding that the ILWU member receiving the “sponsorship” would visit, and encourage other team members to visit, Port Medical.
According to the evidence, Port Medical chart entries were falsified to indicate that ILWU members and their dependents, including children as young as 5 years old, had received repeated chiropractic services, including multiple sessions of massage therapy, that they had not, according to authorities.
To accomplish this, ILWU members were asked to sign their names on multiple sign-in stickers that were used to create the fabricated chart entries, or their signatures on stickers affixed to the chart entries were simply forged.
Other evidence related to instructions provided to Port Medical massage therapists on how to craft chart entries to maximize billing and make services appear to be medically necessary, a requirement for them to be covered by the ILWU-PMA Welfare Plan, according to officials.
Included were instructions to massage therapists never to write that a patient had indicated “no complaints,” and to make sure not to copy or write chart entries “exactly the same each time, change things up a little!!!”
Over the life of the fraudulent scheme, the medical management companies controlled by Amador and Gomez received at least $3 million that derived from funds paid by the Welfare Plan to Port Medical.
“Defendant Gomez concocted an elaborate scheme to enrich himself at the expense of his colleagues, their families and the insurance plan that protected their health,” said Deirdre Fike, the Assistant Director in Charge of the FBI’s Los Angeles Field Office. “This successful prosecution was the result of a long-term effort by agents and prosecutors dedicated to combating health care fraud.”
Amador pled guilty earlier this year to one count of mail fraud and is scheduled to be sentenced in April, according to officials.
The case against Gomez and Amador was investigated by the U.S. Department of Labor – Office of Inspector General, Office of Investigations; the U.S. Department of Labor – Employee Benefits Security Administration; and the Federal Bureau of Investigation.