Largest Health Insurance Fraud Ever

by AdminJ on August 10, 2009

$154 million dollar Health Insurance Fraud! I thought I would change it up a little and blog about other things then Health Insurance Reform.


In what is believed to be the largest medical fraud prosecution in the nation, an Orange County, California woman has been sentenced to 10 years in prison for her role as a “capper” in a $154 million health insurance fraud scam that involved recruiting patients to undergo unnecessary surgeries in exchange for money and/or low-cost cosmetic surgeries.

All told, Sue Nanda pocketed $2.35 million between Nov. 14, 2001, and May 27, 2004, for her work as a “capper” for the now closed Unity Outpatient Surgery Center in Buena Park, California. A “capper” is essentially a recruiter or marketer that, in the context of this massive $154 million health insurance fraud, would round up patients to undergo unnecessary surgical procedures in exchange for a piece of the action.

Apparently, Sue Nanda was quite the little “capper”, recruiting 310 patients to undergo all sorts of unnecessary surgeries for a $2.35 million piece of the action. For all her efforts in pulling off this huge health insurance scam, Orange County Superior Court Judge Frank Fasel rewarded Nanda by sentencing her to 10 years in prison.

If you ask Deputy District Attorney Risk Welsh, Nanda got off light as felt a health insurance scam of this magnitude was worthy of the maximum prison sentence of 20 years.

As for Nanda, her criminal defense lawyer, E. Thomas Dunn, argued for probation at sentencing on the grounds that his client was nothing more than an “unsuspecting Laotian girl” recruited into this huge health insurance fraud scam unaware that her activities were illegal. Let’s just say that Judge Fasel wasn’t buying it.

According to the Orange County District Attorney’s Office, the $154 million Unity health insurance fraud case was the largest medical fraud prosecution in the nation. Nanda was actually just one of eight “capers” used in the scam that has resulted in charges against three doctors and a lawyer as well. While most of the other defendants are either awaiting sentencing or trial, one doctor, Dr. William J. Hampton, was sentenced to 16 years in prison for his role in this health insurance fraud.


I’m sure she will give up all the others names involed and get a shorter sentence. Insurance claims are hard enough to get paid out for real medical problems let alone all fraud.


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