California Capper Gets 1 Year for Role in $154M Insurance Scam

One California woman, who has been known to many as a “capper,” has struck a deal with prosecutors and has pleaded guilty for her role in what is being called “the largest medical fraud prosecution in the nation.”

A capper is someone who illegally recruits healthy patients to undergo unnecessary and often dangerous surgeries so medical practices can earn the health insurance payments.

According to the OC Weekly, 60-year-old Pancha Keophimone was sentenced to one year in prison. She is also set to face a restitution hearing next year on May 18, 2012, when she will likely have to pay back the money that she illegally obtained from the $154 million scam that recruited thousands of phony patients from across the country.

Keophimone, who worked at the now-obsolete Unity Outpatient Surgery Center, pled guilty back in August to an offer of 56 felony counts, which includes conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million.

The Orange County District Attorney’s office (OCDA) reports that Keophimone was technically sentenced to 12 years in state prison, but she will only have to serve that if she violates the terms of her five years probation.

Keophimone personally recruited 118 patients from 17 different states for 297 surgical procedures. This resulted in more than $8 million in billings to insurance companies for unnecessary surgical procedures.

Unity, whose cappers recruited a total of 2,841 people, targeted businesses in 39 states with PPO insurance plans. The company transported the patients to their facility, scheduled the surgeries (usually on weekends) and coached the healthy on what to say to avoid raising suspicions. Patients were paid after the procedures in cash or credits for cosmetic surgery.

When viewing this case by the numbers, we see that 19 defendants were charged and 13 were indicted in June of 2008 by the Orange County Grand Jury, which examined 1,054 exhibits and heard testimony from 56 witnesses over 28 days. Among the indicted are an attorney, an accountant, three doctors and other cappers. Several of the indicted are listed below:

• Surgeon Dr. William Wilson Hampton, Jr., 56, who pled guilty in May of 2009 to 47 felony counts including conspiracy, insurance fraud, and capping. He was sentenced to 16 years in state prison.
• Doctor Michael Chan, 65, who pled guilty in August to 40 felony counts including conspiracy to commit insurance fraud, insurance fraud, aiding and abetting capping with white collar crime sentencing enhancements. He is set to be sentenced on March 9, 2012 in Santa Ana, where he will face anywhere from probation to up to 28 years in state prison.
• Capper Sue Nanda, 43, who pled guilty in February of 2009 to 22 felony counts including conspiracy, capping, grand theft, filing false tax returns, failing to file tax returns, and making false and fraudulent statements. She was sentenced in August of 2009 to 10 years in state prison and ordered to pay more than $500,000 in restitution for personal and corporate back taxes.
• Capper Maria DeJesus Licea Rosales, 44, pled guilty in August of 2009 to 96 felony counts including conspiracy, capping, insurance fraud, grand theft, filing fraudulent tax returns, and sentencing enhancements for white collar crime and loss over $2.5 million. She received a sentence of 8 years in state prison.
• Capper Olga Lilia Toscano, 41, pled guilty in August of 2009 to 98 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. She was also sentenced to 8 years in state prison.
• Capper Ngoc Huynh, 51, pled guilty in August to 56 felony counts including conspiracy, capping, insurance fraud, grand theft, tax evasion, filing a false income tax return, and sentencing enhancements for aggravated white collar crime and loss exceeding $2.5 million. He faces a maximum of 45 years and 8 months in state prison when he is sentenced on January 6, 2012 in Santa Ana. Capper Thuy Huynh, 53, is also scheduled to be sentenced there that morning.

Unity administrators Tam Vu Pham, 46, Huong Ngo, 45, and Lan Nguyen, 55, pleaded guilty to recruiting doctors and cappers for the scheme. Pham, the primary perpetrator, received 12 years in state prison.

Yet to be tried are Roy Dickson, 63, and Andrew Harnen, 57, who are scheduled to go before a jury on December 12^th. Mario Rosenberg, 64, is set to face a pre-trial hearing on January 13, 2012.