Physician Charged with Insurance Fraud Arising out of Workers Compensation Submissions

Dr. D. Gary Martinovsky Charged with Insurance Fraud

Dr. Martinovsky had previously been accused of crimes, won that case and successfully sued.  He has recently passed away and that emphasizes just how reckless charges against innocent doctors can have dire consequences.

In December 2022, Dr. D. Gary Martinovsky faced 40 charges of insurance fraud under PC 550(a)(5), PC 550(a)(7), and PC 550(a)(8) for fraudulent billing, double billing, and billing for services not rendered. His mother-in-law, office assistant, and his medical corporation, Integrated Pain Care (IPC), were also charged.

When a medical corporation is charged, different rules regarding privilege apply. Individuals retain their personal rights, but the Fifth Amendment’s right against self-incrimination applies only to natural persons, not corporations (see Braswell v. United States, 1988). This means all corporate records must be turned over, even if they incriminate the physician owner. The doctor, as an agent of the corporation, does not have personal privileges in this context.

Dr. Martinovsky’s charges stem from California’s generic insurance fraud statute, Penal Code section 550. The prosecution alleges fraudulent billing, double billing, and billing for services not rendered. Although the charges are not under a specific Workers’ Compensation statute, the claims are based on liens filed with the State of California Division of Workers’ Compensation. Part of the charges involves duplicate billing, with allegations of intentional submissions for reimbursement for work already paid in full or in part.

The prosecution also claims that Dr. Martinovsky and billed for services not actually provided. The news releases do not yet disclose full details but you can be certain that numerous undercover agents went to the medical practice.

In large cases such as this, the investigation and the undercover operations are directed by the State Department of Justice in conjunction with the California Department of Industrial Relations. The process is usually started by insurance companies through their own investigations and complaint(s). In this particular case the news release indicates that the case was developed through an investigation conducted by the San Francisco District Attorney’s Office Economic Crimes Unit, with the California Department of Insurance assisting in the arrests.

There are many defenses to Penal Code section 550 charges.  Some are highly technical and others focus on how insurance companies fund and profit from criminal charges filed against doctors.  Remember that any large billing operation will make errors.  Honest mistakes or disagreements on medical issues are not crimes.  For people such as Dr. Martinovsky, his family and staff the mere filing of charges is devastating.

PBS has a documentary title "The Myth of Workers Compensation Fraud".  The PBS website describes the show this way:

In recent years, the insurance industry's focus on cheaters and malingerers helped push through national workers' compensation reform, a profitable cost-cutting campaign supported by outrage over alleged abuse of the system. The problem, however, is that the fraud image is false for the vast majority of workers' compensation cases. Studies show that only 1 to 2 percent of workers' compensation claims are fraudulent. 1 2 Certainly, the tens of thousands of workers killed every year were hardly aiming for a free ride on their employer's tab.  Watch the PBS WC Fraud Program

Expert Legal Defense for Workers’ Compensation Fraud

Many doctors hesitate to take on workers’ compensation cases due to the fear of being unfairly charged with crimes. If you are a doctor or patient under investigation for workers’ compensation fraud, you need immediate legal assistance.

The Horowitz Law Office specializes in medical fraud defense. With over 15 years of experience, our team successfully defended a medical fraud case at trial, where Dr. Martinovsky provided services to patients of the charged medical office. If you are facing medical fraud charges, Daniel Horowitz is your top choice for expert legal representation.

Contact us today for a consultation.