Andrew L. Sokol Sentenced to Over Four Years for Health Care Fraud

Source- http://www.fbi.gov/atlanta/press-releases/2011/atlanta-chiropractor-sentenced-to-over-four-years-for-health-care-fraud

ATLANTA, GA—ANDREW L. SOKOL, 43, of Marietta, Georgia, was sentenced today by Chief United States District Judge Julie E. Carnes to federal prison on charges of conspiracy to commit health care fraud by fraudulently submitting millions of dollars of insurance claims to Blue Cross Blue Shield and other private insurers for physical therapy services that were not actually provided.

United States Attorney Sally Quillian Yates said, “We are all painfully aware of skyrocketing health costs, and when pain is left untreated, the public should not have to cover a phony bill. This defendant received over $6.5 million in payments from Blue Cross Blue Shield and other private insurers after billing them for physical therapy services he did not provide. Frauds like these ultimately affect everyone—individuals, families, and communities—in higher premiums and higher service costs. The prison sentence imposed today shows that health care fraud is a serious crime.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta, said, “The FBI continues to dedicate vast investigative resources to its health care and medicare fraud programs primarily because of the high loss amounts to the U.S. Government that these cases can bring. Individuals such as Mr. Sokol, that were otherwise trusted individuals within the medical community, abandon that trust for a level of personal greed that cannot be understood and will not be tolerated.”

IRS-Criminal Investigation Special Agent in Charge Reginael McDaniel said, “Our system of health care is founded on the trust in our health care professionals and the outstanding services they provide. The system was not designed for a few rogue individuals who choose to place personal profit ahead of that trust.”

“This defendant’s criminal activity will eventually be felt by all of the American public. He not only took advantage of the health care system, but the honest people that do right by the system. Today’s sentence will give the defendant plenty of time to think about the consequences of his actions.” said Martin D. Phanco, U.S. Postal Inspector in Charge of the Atlanta Division.

SOKOL was sentenced to four years, 9 months in prison to be followed by three years of supervised release, and was ordered to pay restitution in the amount of $6,599,456. SOKOL was convicted of these charges on October 21, 2010, after his plea of guilty.

According to United States Attorney Yates, the charges and other information presented in court: SOKOL was a licensed chiropractor who owned and operated “WellnessOne” chiropractic clinics in Marietta, Buckhead, Duluth, Vinings, and other locations throughout metro Atlanta.

WellnessOne offered massage, personal training, and chiropractic services to its patients, but fraudulently billed these services to insurance companies as physical therapy. SOKOL targeted MBNA and Bank of America employees because the Blue Cross Blue Shield policies covering those employees provided generous chiropractic and physical therapy insurance benefits. To attract these “patients” to WellnessOne clinics, SOKOL designed frequent promotions, giving bank employees who came in for a massage or chiropractic adjustment gift cards in the amount of $50, $25, or $10, and restaurant and free gasoline cards; raffle tickets offering the chance to win BMW and Hummer leases or $5,000; frozen turkeys and pies at Thanksgiving and Christmas; gift bags containing supplements, vitamins, lumbar and cervical pillows, and weight loss patches; and free catered lunches in the clinics.

SOKOL implemented other mass-marketing techniques to further his scheme, such as a billboard on I-75, a major interstate, that advertised his clinics, and direct mailings to the public indicating that patients could receive massages and have their insurance pay for it. SOKOL also routinely waived patients’ co-payments and deductibles, resulting in the patients being compensated—with gift cards and other items of value—while paying nothing for the massages and chiropractic adjustments they received at WellnessOne.

The evidence showed that from January 2005 through September 2007, SOKOL employed licensed medical doctors and physical therapists in order to bill a massage as physical therapy, even though these licensed providers never saw the majority of patients. Instead, massage therapists actually gave the massages. Several medical providers quit when they realized WellnessOne was billing insurers under their names for services they did not perform. In addition to using false provider names and billing codes, SOKOL directed that services be billed on different days and under different tax identification numbers to conceal the fraud from insurers.

Beginning in 2006, SOKOL permitted patients to visit a local gym in the Atlanta area and then fraudulently billed those gym visits to insurers as physical therapy. When that arrangement ended, SOKOL had small gyms built in the WellnessOne clinics and fraudulently billed personal training sessions to insurers as physical therapy.


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