Two Southland women are facing lengthy federal prison terms for defrauding union and private health insurance firms out of tens of millions of dollars for medically unnecessary procedures performed on insurance beneficiaries who received free or discounted cosmetic procedures.
Theresa Fisher, 45, of Tustin, and Lindsay Hardgraves, 30, of San Pedro, were convicted Thursday following a six-day jury trial.
Fisher was found guilty of five counts of mail fraud and Hardgraves was convicted of two counts. They face up to 20 years in prison for each count.
The duo and another defendant who was previously convicted submitted bills for more than $71 million and received more than $50 million in payments, according to federal prosecutors.
A large number of the fraudulent claims were submitted to the International Longshore and Warehouse Union and Operating Engineers Union health plans, as well as Aetna and Anthem.
Evidence showed insured “patients” were lured to a surgery center in Orange by being told they could use their union or PPO health insurance plans to pay for cosmetic procedures that are generally not covered.
Hardgraves was a marketer who found “patients” for the center, and Fisher and the third defendant acted as consultants who scheduled procedures after coaching people to fabricate or exaggerate symptoms to get their medical procedures covered by their insurance, according to prosecutors.
Customers were told they could get free or discounted cosmetic surgeries if they underwent multiple medically unnecessary procedures such as endoscopies and colonoscopies that would be billed to their insurance. In return, they got no-charge tummy tucks, breast implants and liposuction.
In some instances, even the cosmetic surgeries were billed to insurance companies as medically necessary, according to prosecutors, who said the surgery center was variously known as Princess Cosmetic Surgery, Vista Surgical Center and Empire Surgical Center.
U.S. District Judge Josephine Staton is scheduled to sentence the duo on May 29.
Vi Nguyen, 31, of Placentia, pleaded guilty in January to four counts of mail fraud and is scheduled to be sentenced July 10.
— City News Service