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Doctors billing for unnecessary treatment. Patients using insurance papers that don’t belong to them. With more of these kinds of insurance fraud stories coming to light, the Santa Clara County DA’s office has formed a new team to keep up. The health and disability insurance fraud unit � made up of two investigators, a prosecutor and a part-time paralegal � has been up and running for the last six months after receiving a $450,000 grant from the state Department of Insurance for the current fiscal year. “The problem has been existing in our community for a long time,” said Supervising Deputy DA Scott Tsui. But until recently, prosecuting such crimes has lacked a cohesive focus. Assistant DA Stephen Gibbons said he hopes that, much like an existing workers’ compensation fraud program that has grown over the last two to three years, the new health and disability fraud unit will get additional state funding in the future. Santa Clara County isn’t the only community to receive a grant. San Francisco got $100,000, and the Department of Insurance also made awards to San Diego, Orange and Los Angeles counties. But given its size, “Santa Clara is definitely on the cutting edge in terms of recognizing a very serious economic crime and then doing something about it,” said Frank Scafidi, spokesman for the National Insurance Crime Bureau, a nonprofit organization based in Chicago, who predicts there will be much work for the new unit. Before applying for the grant last year, the DA’s office was actively examining three medical fraud cases, Tsui said. And according to a Dec. 5 memo the DA’s office presented to the county Board of Supervisors, the unit has since found nine potential medical provider fraud cases. Six of them involve surgical centers: In several cases, cosmetic surgeries were being billed as medical procedures. In another case, a chiropractor was multiplying the number of some patients’ visits and billing for them, the memo stated. Although the office receives many tips from insurance companies and patients suspicious of their medical providers, prosecutors may not be able to investigate them if resources are not available, according to Tsui. “The better equipped we are and the more knowledgeable we are, we are better off in this fight against insurance fraud,” Tsui said. “It allows us to get ourselves more focused.” And while he declined to comment on the specifics of the cases under investigation � fearing it could tip off perpetrators � Tsui said the scenario of chiropractors falsely billing insurance companies is one of the more common reports. In one well-publicized federal case, a Southern California group pleaded guilty last week to fraud charges for recruiting hundreds of elderly patients to a fake clinic in Milpitas and billing nearly $1 million from the federal Medicare program, according to the San Jose Mercury News. Many cases, however, are not so clear-cut, and successfully prosecuting them requires much finesse. Finding evidence is key and often requires creative tactics such as infiltrating a clinic, according to Dominic Dugo, a deputy DA in San Diego who started a task force addressing medical fraud. Typically, those techniques require search warrants, he said. And when it comes time to prosecute, expert medical testimony from the defense and prosecution could conflict, Scafidi said. That could mean a prosecutor must have the expertise to convince a jury that a defendant’s soft tissue injury is a scam. Over the last three years, the DA’s office has gone after more than a dozen chiropractors, two attorneys and people posing as lawyers � all for setting up false claims and medical billing procedures, according to the DA’s December report.

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