Chicago Doctor Convicted for Fraudulently Billing Insurers for Non-Performed Services

December 17, 2018

A federal jury has convicted a Chicago doctor on fraud charges for billing insurance companies for purported chiropractic manipulations that were never performed, the U.S. Attorney’s Office for the Northern District of Illinois reported.

Anesthesiologist and pain management specialist Dr. Paul Madison owned Watertower SurgiCenter LLC, an outpatient surgical center on North Michigan Avenue in Chicago. From 2005 to 2009 Watertower’s billing staff submitted false bills to insurers for manipulation-under-anesthesia that had not actually been performed by the center’s chiropractors, the U.S. Attorney’s Office said.

Dr. Madison and others falsified patient records to support the fraudulent health insurance claim forms and submitted the claims to patients’ insurance companies. In at least two instances, Dr. Madison included in the fraudulent billings names, addresses and dates of birth of patients without their knowledge, according to prosecutors.

The jury in federal court in Chicago convicted Dr. Madison, 65, of Chicago, on all 11 counts against him. The conviction includes six counts of healthcare fraud, three counts of making false statements in connection with the delivery of healthcare services, and two counts of aggravated identity theft. Sentencing is set for March 25, 2019.

Each count of healthcare fraud is punishable by a maximum sentence of 10 years in prison, while each false statement count carries a maximum penalty of five years. Each aggravated identity theft count carries a mandatory consecutive sentence of two years.

The verdict was announced by John R. Lausch, Jr., United States Attorney for the Northern District of Illinois; Jeffrey S. Sallet, Special Agent-in-Charge of the Chicago office of the Federal Bureau of Investigation; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor’s Office of Inspector General in Chicago.

Assistant U.S. Attorneys Edward G. Kohler and Jennie Levin represented the government.