Mark Allen Darner, D.C., of Arlington, Tex., was sentenced recently to pay more than $2.7 million in restitution, following his July 2001 guilty plea to conspiracy to commit mail fraud.

According to United States Attorney Richard H. Stephens, Dr. Darner, admitted that from 1996 through 2000, he was involved in a conspiracy to defraud patients and insurance companies by submitting false claims for medical services claimed to have been performed and receiving payment for these services from those insurers.

Darner admitted that during this time, he submitted approximately $5.7 million in false medical claims to insurance companies.

Of that, approximately $3.2 million was paid by insurance companies on the fraudulent claims. "Not only did Darner's scheme defraud insurance companies of millions of dollars, he deprived his patients of the full, honest medical care they thought they were receiving," Stephens stated.

As part of his scheme, Darner billed for services that required a provider to be face-to-face with a patient, when in fact, no doctor even saw the patient. Routine MRI's and X-rays were falsely billed because the results were not read by professionals as required.

"Darner would diagnose based on how much an insurance company would pay for the diagnosis, not based on a valid medical evaluation of the patient," a press release from the U.S. Department of Justice explained. "All patients received the same basic multiple diagnoses which provided for and falsely justified multiple diagnostic tests and medical procedures which caused the insurance company to pay the claims."

As a further part of his conspiracy, Darner falsified patients' treatment charts to reflect CPT code designations for certain services he billed when the patients actually were provided either some lesser service or no service at all. These false medical records were maintained so that when insurance companies demanded medical documentation of a claim, the false medical record could be sent to the insurer to facilitate claim processing and payment.

Darner established spurious medical clinics in work-out facilities/health clubs and club members were solicited as patients. In fact, as part of the conspiracy, Darner recruited young chiropractic students and graduates to work in his "medical clinics" in the health clubs and they were instructed to conduct medical tests that they were not qualified nor trained to perform in order to facilitate fraudulent billings to insurance companies.

After the medical billing scam would reach fruition, Darner would attempt to sell the fraudulent practice to the chiropractor he had recruited, based on the millions of dollars in future income to be derived from the health club "medical clinic" practice.

Most of the individuals who became patients at Darner's health club "medical clinics" were not even looking for or in need of medical care, testing or treatment, but had only gone to the health club to work out.

Patients' insurance companies were billed for rehab medical services based simply on the patient entering the health club and working out, just as the member had intended as the real reason for being at the health club.

To further carry off his scheme, Darner and his co-conspirators established various companies and professional associations to make it appear to patients, insurance companies and investigators they had responsibility for patient care and treatment for billing purposes. Some of these shell entities were MedFit and Medica Partners, Mediworks Inc., Primus Healthcare, Powerhouse Medical Clinic, and Medsport, LLP. Darner admitted that these entities were established to hide the true responsibility for patient care and treatment and to make it appear that legitimate businesses were involved.

As a part of the scheme, doctors' names and credentials were shown as treating physicians on claims submitted to insurance companies when the doctor listed never saw the patient nor supervised any treatment. Darner and others falsified patients' treatment records to support fraudulent billings by obtaining other doctors' signatures on patient charts to make it look like the doctor was treating or supervising the treatment, when he was not. Co-conspirator doctors' names and signatures were placed on medical tests when the doctor did not perform the test, supervise the test, interpret the test or read the test.

Darner fraudulently billed for medical tests that were either not performed, not performed by a qualified person, not used or read for diagnostic purposed by a qualified provider, or not reasonable or necessary to the honest performance of any health care service for the patient. Darner even purchased specialized medical equipment that he and his co-conspirators used to fraudulently bill for both diagnostic and physical medical treatments knowing the machines did not provide medically necessary treatments, were not used for a valid purpose, and were not used by trained licensed professionals.