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12 Apr 2013

Unlicensed physician charged with fraud

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April 12, 2013 Category: Local Posted by:

The Philadelphia District Attorney’s Office has charged 63-year-old Patrick Usanga of Folcroft, PA with Insurance Fraud, Attempted Theft by Deception, Theft by Deception and Tampering with Public Records or Information for operating a medical practice without a license.

 

Detectives from the District Attorney’s Office Insurance Fraud Unit , along with the assistance of agents from the Social Security Administration and the United states Department of Labor began to investigate Usanga in 2012 after receiving a referral from an Independence Blue Cross investigator. Usanga operated Northeast Behavioral Medicine located on the 6800 block of Castor Avenue and incorporated the business as a medical clinic providing psychiatric and chemical treatment counseling.  No employee at the facility, including Usanga, himself, was licensed to provide such treatment. 

 

The investigation found that Usanga billed both Independence Blue Cross and Aetna Insurance for mental health procedures that he was not licensed to perform. Further allegations include that Usanga billed Independence Blue Cross for over fifteen thousand dollars and Aetna Insurance for over $5,000 while operating this facility.

 

Detectives interviewed Independence Blue Cross insured who were former patients of Northeast Behavioral Medicine. The interviews revealed several discrepancies between patient accounts and forms submitted by Usanaga to the insurance company. The patients identified Usanga as their doctor during their time of treatment; however, claim forms submitted to the insurance company list other employees of the center as medical providers at the patients’ time of treatment.

 

Detectives checked the Pennsylvania Department of State database and discovered that the employees listed as medical providers held no professional licenses. Detectives also reviewed claim forms submitted to Aetna Insurance Company. These forms routinely list three Northeast Behavioral Medicine employees as medical providers, none of whom are registered as holding professional licenses. 

 

In addition to committing insurance fraud by billing insurance companies for services rendered by an unlicensed practitioner, Usanga was also charged with Theft by Deception for allegedly receiving checks from the Pennsylvania Unemployment Compensation System. Usanga first filed for unemployment in March of 2009. Over the next two years, Usanga received over $55,000 in unemployment compensation.

 

Records show that Usanga had treated patients, submitted medical forms to insurers and received payment during the period in which he was claiming to be unemployed. Usanga is also accused of Tampering with Public Records for submitting multiple extended benefit claims forms to the Pennsylvania Unemployment Compensation system alleging that he was looking for work at Northeast Behavioral Medicine, the same facility which he operated himself.   

 

In 2012, the Department of Public Welfare revoked Northeast Medical Center’s license after learning that the center did not employ any licensed doctors and/or counselors. 

 

ADA Linda Montag and Detective Karl Supperer of the District Attorney’s Insurance Fraud Unit are specially assigned to this case.  Usanga was arrested this morning by DAO Insurance Fraud Detectives with the help of detectives from the Delaware County District Attorney’s Office Insurance Fraud Unit.  Usanga is currently being processed by the Philadelphia Police.

 

Complete list of Charges:

 

• Insurance Fraud – F3 (27 counts)

• Attempted Theft by Deception – F3 (27 counts)

• Theft by Deception – F3 (11 counts)

• Tampering with Public Records or Information – F3 (10 counts)

 

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