A Menifee physician who billed insurance companies for bogus work and lied about his license status was sentenced Tuesday to five years felony probation and ordered to complete 100 hours of community service.
Dr. Benjamin Gould Cox, 87, was convicted by a Riverside jury last month of seven counts each of insurance fraud and perjury.
Riverside County Superior Court Judge Thomas Glasser imposed a low-end sentence because Cox has no prior convictions. The defendant was facing a maximum 18 years in prison.
In addition to probation and community service, the judge ordered Cox to pay victim restitution, in an amount to be determined by the Department of Probation.
According to the District Attorney’s Office, Cox committed the offenses while serving patients involved in workers’ compensation insurance claims.
Prosecutors said the defendant, who has been practicing medicine since the early 1960s and has been previously disciplined for professional violations, came to the attention of authorities after the California Department of Industrial Relations learned he had been fraudulently billing for “medical-legal reports” tied to workers comp cases.
The reports are required by the state Workers’ Compensation Appeals Board when a dispute arises between an injured worker and his or her insurer.
Cox was representing himself as a qualified medical evaluator, or QME, to insurance companies and creating reports to resolve nonexistent disputes, according to prosecutors. He sent QME reports to Berkshire Hathaway, Employers Insurance, The Hartford, Liberty Mutual, the State Compensation Insurance Fund, Zenith Insurance and Zurich Insurance, seeking a total $90,000 for reports that were never commissioned, prosecutors said.
The Department of Industrial Relations, which designates QMEs, confirmed to investigators that the doctor was not among its active designated reviewers, though years before he had been one. Cox continued to identify himself in statements to the California Medical Board as a QME, despite the lapse of his certification, resulting in acts of perjury, according to the prosecution.
The board in 2013 placed Cox on probation, restricting his practice, because of documented instances in which he had failed to appropriately diagnose and establish treatment plans for a number of patients, according to the California Department of Consumer Affairs.
Cox completed his probation in 2016. But last February, his license was suspended by the board in response to the filing of the criminal complaint that ultimately led to his conviction.
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