Thursday, August 22, 2013
Police: Middletown chiropractor fraudulently billed for massages at Newtown gym
Posted: Friday, July 19, 2013
A Middletown chiropractor associated with the Newtown Athletic Club is accused of fraudulently billing the Philadelphia region’s largest health insurance company for thousands of dollars in regular massages performed by spa employees at the Newtown Township gym.
The Pennsylvania Attorney General’s Office has filed charges against Dr. Christopher Sepanski, 46, who listed addresses in Lower Makefield and Tucson, Ariz., alleging that he billed Independence Blue Cross for non-medical services and services he never performed between 2008 and 2010. The AG’s office alleges Sepanski was fraudulently reimbursed at least $9,808 for massage services to at least eight people.
The chiropractor was arraigned Thursday before Middletown District Judge John Kelly Jr. on charges of fraud, theft, criminal attempted theft, corrupt organizations and conspiracy and released on $10,000 unsecured bail.
The investigation was launched in 2008 after an Independence Blue Cross employee, who also was a member of the Newtown Athletic Club, was told by an employee of the Salon & Spa inside the gym that she could get a free massage — which normally costs $95 — and her health insurance would be billed, according to a probable cause affidavit.
The Courier Times was unsuccessful in attempts to reach Newtown Athletic Club owner Jim Worthington for comment.
The newspaper was also unsuccessful in reaching an attorney general’s office spokesperson for comment.
The Blue Cross employee says when she scheduled her massage appointment, she was asked for her insurance card. The receptionist told her that “Dr. Chris” submits the bills to the insurance company for reimbursement, according to the affidavit.
The patron questioned the employee how a chiropractor could bill for a massage if she never saw or was examined by the doctor, according to court documents. She also told the employee she worked for Blue Cross and was concerned about this billing practice.
The employee subsequently notified Blue Cross’ loss prevention about what she learned. Two undercover investigators were assigned to visit the gym-based salon, where they were told they could get massages and their Independence Blue Cross health coverage would pay for it, court documents said.
The investigators asked salon employees to check to make sure that their health plans would cover the cost and they were told it would be covered, according to the attorney general. One investigator was specifically told she was entitled to 12 massages a year, court documents said.
But before they could get the massages, the investigators were told they had to see Sepanski at his Middletown chiropractic office. The attorney general alleges that Sepanski billed the massages as medical procedures performed by a medical professional at the Middletown medical office.
The investigators made separate appointments with Sepanski, but both claimed they were not examined nor had any chiropractic treatments. Both described the consultation as lasting seven minutes, according to the affidavit.
During the consultations the undercover employees said Sepanski asked if they were seeking massages to relax or for a medical problem. Both answered the massages were for only relaxation, according to the affidavit.
One of the investigators said that during her consultation, Sepanski told her that if she received anything in the mail asking about the “date of accident” to let him know, according to the affidavit.
The investigators subsequently scheduled and received 21 and 18 massages, which were performed at the NAC salon by salon employees, according to the affidavit. On nine occasions, the investigators were asked to sign a blank doctor’s “exam form” from Sepanski’s chiropractic office. Both were billed for Saturday massages that they never received, according to the affidavit.
A former salon employee interviewed by investigators said the salon manager told her to ask clients if they had health insurance. If they had coverage, she was told to ask if they wanted massages and the health plan would pay for it.
The employee, who had Blue Cross health coverage, said she received seven “free” massages at the salon and only signed a blank medical form and mark if she was in pain to get the massages. She also told investigators she was never examined or treated by Sepanski or anyone at his office, who billed insurance for 13 massages, according to court documents.
The former spa manager at the NAC told investigators that she was told to promote the massage service at the salon and tell members that health insurance would cover it, according to the affidavit. The employee said it was a “common practice” to make a copy of insurance cards of the member who received a massage and have the member sign and date a “medical body sheet” and both items were forwarded to Sepanski.