Pacific Palisades woman, three OC residents indicted in health care insurance fraud scheme
A Pacific Palisades woman and three Orange County residents suspected of orchestrating a scheme that allegedly claimed bogus health care reimbursements on behalf of longshoremen and members of the military face allegations of fraud following their indictment in January, prosecutors said Tuesday, Feb. 4.
James Nate Bell, 38, of Anaheim Hills, Regina Piehl, 66, of Pacific Palisades and Huntington Beach residents Dr. Michael Edwards, 52, and Sara Samhat, 45, were accused of health care fraud, money laundering and other federal offenses in a 48-count indictment filed Wednesday, Jan. 29, which was unsealed Tuesday.
The document alleges that the four defendants benefited from two bogus clinics that funneled unnecessary prescriptions to Professional Compounding Pharmacy (PCP). Bell was the owner of that company, which operated out of La Habra and Brea.
Piehl allegedly collaborated with Edwards to establish weekly pain clinics at a medical spa she owned in Lawndale and a rented space in National City, according to court documents. The clinics were purportedly trials designed to compare the effectiveness of pain relieving compound creams versus more traditional medications.
However, prosecutors believe the clinics were a sham, officials from the U.S. Attorney’s office said in a news release. Authorities believe the defendants sought patients covered by either the military’s TRICARE health plan or the Pacific Maritime Association Welfare Plan, which is offered to members of the International Longshore and Warehouse Union (ILWU).
Those programs were paying especially generous reimbursements to providers supplying medical creams at the time the clinics were conducted. according to court documents. Patients covered with those plans were paid $200 to participate in a phony clinical trial that generated unnecessary prescriptions, prosecutors said. PCP made over $19 million worth of fraudulent claims to Tricare, and filed for over $3 million in bogus reimbursements from the ILWU’s insurance plan managers in 2015 and 2016.
Federal officials allege that Piehl paid commission to Samhat to direct prescriptions to PCP that led to bogus claims for expensive and unnecessary creams. She has denied involvement in any criminal activity, her attorney, Dave Weichert, said.
“She has led an outstanding, law abiding life, and intends to vigorously contest any allegations of wrongdoing,” he said.
Attorneys representing others accused in the indictment were not immediately available to comment on the case.
Federal agents arrested Bell and Piehl on Tuesday. Edwards and Samhat were expected to surrender themselves into law enforcement custody Wednesday at the federal courthouse in Santa Ana.