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Published On: Thu, Sep 27th, 2018

Louisville: Claudie Lopez sentenced in $5 million health care and insurance fraud scheme

U.S. District Judge Rebecca G. Jennings sentenced Claudia Lopez, age 40, from Fountain, Colorado, to 61 months imprisonment, followed by 3 years of supervised release this week for her part in a scheme to fraudulently bill insurance companies $5 million, announced United States Attorney Russell M. Coleman.

“We will not allow thieves to continue to use the complexity of our health care delivery system as a means to commit their crimes,” stated United States Attorney Russell M. Coleman.  “Health care fraud will continue to be aggressively prosecuted in the Western District of Kentucky.”

The Court also ordered Lopez to pay restitution of $232,617.96, as well as a $1,300 Special Penalty Assessment and to forfeit an Audi Q-7 and $53,775 in proceeds.

According to the evidence before the Court, beginning no later than on or about June 12, 2012, and continuing through on or about November 1, 2014, Lopez, Ledinson Chavez, Oskel Lezcano, Ariel Borrego-Hernandez, Sergio Betancourt and Yuriesky Diaz Rodriguez recruited unsuspecting chiropractors for employment in Louisville area chiropractic clinics in order to obtain and use the chiropractors’ names and National Provider Identifiers (NPI) to fraudulently bill insurance companies. Each chiropractor provided his/her National Provider Identifier (NPI) number to Lopez and Lezcano in order to credential the clinics with various insurance companies.

photo/ Nick Youngson

Thereafter, the group of defendants recruited employees from Jeffboat and others to seek chiropractic services from the clinics. However, unbeknownst to the chiropractors, the clinics billed over $5,000,000 for methocarbamol injections (a muscle relaxant), using the patients’ names, dates of birth, insurance/policy numbers, addresses, and patient IDs/Social Security Numbers for injections. Most of the patients from Jeffboat were paid to go to the clinics by the defendants and were told the injections were being billed, according to testimony during trial.

Lopez, Lezcano, Borrego-Hernandez, Betancourt, and Chavez operated and controlled multiple chiropractic clinics in the Louisville area including: Xpress Diagnostics Center, Inc.; Prudential Chiropractic Medical Center, PLLC; Klondike Chiropractic Medical Center, LLC; Be Well Chiropractic Center, Corp.; Chiropractic and Medical Center, LLC, even though the clinics were placed in various chiropractors’ names.

Assistant United States Attorneys Joseph Ansari, Lettricea Jefferson-Webb and Christopher Tieke prosecuted the case and were assisted by Bob Masterson as health care fraud investigator. The case was investigated by the Federal Bureau of Investigation, the United States Postal Inspection Service, the Internal Revenue Service Criminal Investigation, the Louisville Metro Police Department, and the National Insurance Crime Bureau.

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