Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 1 of 11
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1 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 1 of David B. Shemano (State Bar No ) PEITZMAN, WEG & KEMPINSKY LLP Santa Monica Blvd., Suite 1450 Los Angeles, CA Telephone: (310) Telecopier: (310) Marvin Wexler Lawrence C. Fox KORNSTEIN VEISZ WEXLER & POLLARD, LLP 757 Third Avenue New York, NY Telephone: (212) Telecopier: (212) Attorneys for Creditors Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross and Blue Shield of Michigan, Blue Cross and Blue Shield of Nebraska, Blue Cross and Blue Shield of North Carolina, Blue Cross and Blue Shield of Tennessee, Inc., CareFirst Blue Cross and Blue Shield, Empire HealthChoice Assurance, Inc. dba Empire Blue Cross Blue Shield, Excellus Health Plan, Inc. and R.M.S.C.O., Highmark, Inc., Premera Blue Cross, Regence Blue Shield, Regence Blue Cross Blue Shield of Utah, Regence Blue Cross Blue Shield of Oregon, and Regence Blue Shield of Idaho UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA LOS ANGELES DIVISION In re LARS ERIK HANSON, Debtor. Case No.: LA ER Chapter BLUE CROSS AND BLUE SHIELD OF ALABAMA, BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC., BLUE CROSS AND BLUE SHIELD OF MICHIGAN, BLUE CROSS AND BLUE SHIELD OF NEBRASKA, BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA, BLUE CROSS AND BLUE SHIELD OF TENNESSEE, INC., CAREFIRST BLUE CROSS AND BLUE SHIELD, EMPIRE HEALTHCHOICE ASSURANCE, INC. dba EMPIRE BLUE CROSS BLUE SHIELD, EXCELLUS HEALTH PLAN, INC. AND R.M.S.C.O., HIGHMARK, INC., PREMERA BLUE CROSS, REGENCE BLUE SHIELD, REGENCE BLUE CROSS BLUE SHIELD OF UTAH, REGENCE BLUE CROSS BLUE SHIELD OF OREGON, AND REGENCE BLUE SHIELD OF IDAHO, vs. LARS ERIK HANSON, Plaintiffs, Defendant. Adv. No. COMPLAINT TO DETERMINE NONDISCHARGEABILITY OF DEBTS
2 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 2 of Plaintiffs Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross and Blue Shield of Michigan, Blue Cross and Blue Shield of Nebraska, Blue Cross and Blue Shield of North Carolina, Blue Cross and Blue Shield of Tennessee, Inc., CareFirst Blue Cross and Blue Shield, Empire HealthChoice Assurance, Inc. dba Empire Blue Cross Blue Shield, Excellus Health Plan, Inc. and R.M.S.C.O., Highmark, Inc., Premera Blue Cross, Regence Blue Shield, Regence Blue Cross Blue Shield of Utah, Regence Blue Cross Blue Shield of Oregon, and Regence Blue Shield of Idaho (collectively, Plaintiffs or the Blue Plans ), allege as follows: JURISDICTION AND VENUE 1. The above-captioned debtor filed a voluntary petition for relief under Chapter 7 of the Bankruptcy Code in the Central District of California on January 16, 2008 (the Petition Date ). 2. This action is a core proceeding and this Court has jurisdiction pursuant to 11 U.S.C. 523, 28 U.S.C. 157(b) and 1334(b), and Rules 4007 and 7001(6) of the Federal Rules of Bankruptcy Procedure. Venue in this judicial district is proper pursuant to the provisions of 28 U.S.C. 1409(a). PARTIES 3. Plaintiff Blue Cross and Blue Shield of Alabama is an Alabama not-for-profit corporation with its principal place of business in Birmingham, Alabama. 4. Plaintiff Blue Cross and Blue Shield of Massachusetts is a Massachusetts not-for-profit corporation with its principal place of business in Boston, Massachusetts. 5. Plaintiff Blue Cross and Blue Shield of Michigan is a Michigan not-for-profit corporation with its principal place of business in Detroit, Michigan. 6. Plaintiff Blue Cross and Blue Shield of Nebraska is a Nebraska not-for-profit corporation with its principal place of business in Omaha, Nebraska. 7. Plaintiff Blue Cross and Blue Shield of North Carolina is a North Carolina not-for-profit corporation with its principal place of business in Durham, North Carolina. 8. Plaintiff Blue Cross and Blue Shield of Tennessee, Inc. is a Tennessee not-for-profit 1
3 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 3 of corporation with its principal place of business in Chattanooga, Tennessee. 9. Plaintiff CareFirst Blue Cross and Blue Shield is a Maryland not-for-profit corporation with its principal place of business in Baltimore, Maryland. 10. Plaintiff Empire HealthChoice Assurance, Inc. dba Empire Blue Cross Blue Shield is a New York corporation with its principal place of business in New York, New York. 11. Plaintiff Excellus Health Plan, Inc. ( Excellus ) is a New York not-for-profit corporation with its principal place of business in Rochester, New York. Excellus operates certain of its business through a wholly-owned subsidiary, plaintiff R.M.S.C.O., which is a New York corporation with its principal place of business in Fayetteville, New York. 12. Plaintiff Highmark, Inc. is a Pennsylvania not-for-profit corporation with its principal place of business in Pittsburgh, Pennsylvania. 13. Plaintiff Premera Blue Cross is a Washington not-for-profit corporation with its principal place of business in Mountlake Terrace, Washington. 14. Plaintiff Regence Blue Shield is a Washington not-for-profit corporation with its principal place of business in Seattle, Washington. 15. Plaintiff Regence Blue Cross Blue Shield of Utah is a Utah not-for-profit corporation with its principal place of business in Salt Lake City, Utah. 16. Plaintiff Regence Blue Cross Blue Shield of Oregon is an Oregon not-for-profit corporation with its principal place of business in Portland, Oregon. 17. Plaintiff Regence Blue Shield of Idaho is an Idaho not-for-profit corporation with its principal place of business in Lewiston, Idaho. 18. Defendant Lars Erik Hanson ( Hanson or the Debtor ) is the debtor in the abovecaptioned chapter 7 case PLAINTIFFS CLAIMS AGAINST THE DEBTOR 19. Plaintiffs are health insurance companies and third-party administrators of health benefit plans that are licensees of the national Blue Cross and Blue Shield Association. All of the Plaintiffs are in the business of underwriting and administering health insurance and employee health benefit plans. 2
4 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 4 of The Debtor is a doctor who was an active and knowing participant in a massive health insurance fraud scheme that is the subject of an action commenced by the filing of a Complaint on March 10, 2005, currently pending in the United States District Court for the Central District of California. That action is captioned Blue Cross and Blue Shield of Alabama, et al. v. Unity Outpatient Surgery Center, Inc. et. al., Case No. SA CV TJH (VBKx) ( the Fraud Action ). A true and correct copy of the Complaint in the Fraud Action is attached hereto as Exhibit A (the Complaint ). The allegations set forth in the Complaint are incorporated herein by reference. 21. As set forth in the Complaint, the defendants in the Fraud Action, including the Debtor, participated in what the California Insurance Commissioner has publicly described as one of the most egregious, outrageous insurance fraud cases in history. Besides the civil Fraud Action, that fraud has led to both State and Federal criminal prosecutions, and several defendants have already pled guilty to criminal charges, including defendants who were co-conspirators with the Debtor. 22. The fraud at issue in the Fraud Action was perpetrated at a group of outpatient surgery clinics in Southern California, including nine outpatient surgery clinics that are the subject of detailed allegations in the Complaint. In summary, the defendants used a nationwide network of patient recruiters to recruit thousands of patients from across the country to come to the clinics and undergo completely unnecessary diagnostic and surgical procedures, so that the clinics and the surgeons could submit millions of dollars of phony insurance claims to Plaintiffs for the unnecessary procedures. 23. To induce the patients to undergo the unnecessary procedures, the clinics (through the recruiters) offered the prospective patients either a cash payment for each unnecessary procedure the patient underwent, or promised the patient free or discounted cosmetic surgery after the patient submitted to multiple unnecessary procedures. The clinics and surgeons made the unnecessary procedures appear medically justified by concocting phony symptoms and diagnoses for the patients and incorporating those fake symptoms and diagnoses in fictitious medical records. The clinics and surgeons then cashed in by submitting fraudulent and inflated bills for the unnecessary procedures to insurers, using the bogus medical records as back-up. 24. Plaintiffs were hit hard by this fraud, collectively paying out more than $10 million on fraudulent insurance claims. 3
5 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 5 of One of the corrupt clinics targeted in the Complaint in the Fraud Action is Newport Superior Outpatient Medical Center ( Newport Superior ), which was located at 1501 Superior Avenue, Newport Beach, California. The Debtor was the sole shareholder of Newport Superior Outpatient Medical Center, Inc. ( Newport Superior Outpatient ), a corporation that nominally owned Newport Superior. The Debtor was also a principal of Newport Superior Management Group, LLC ( Newport Superior Management ), which actually owned and operated Newport Superior. 26. As one of the Debtor s co-conspirators has already testified in criminal proceedings, the Debtor s sole ownership of Newport Superior Outpatient was a sham designed to evade California law. Under California law, an outpatient surgery clinic must be owned entirely by physicians, and laypersons are not permitted to own any interest. The Debtor was made the sole owner of Newport Superior Outpatient to make it appear that a physician was the sole owner of the clinic. In truth, in a separate undisclosed agreement, and as the Debtor well knew, Newport Superior Outpatient had contractually ceded ownership and control of Newport Superior to Newport Superior Management, which was largely owned by laypersons. 27. The Debtor was a principal actor and administrator in the fraud at Newport Superior, was fully aware of the nature and extent of the fraud and how it operated, and personally and directly participated in, and profited from, the fraud. Among other acts, and as detailed in the Complaint in the Fraud Action, the Debtor personally issued checks to patient recruiters for bringing patients to Newport Superior, which was essential to the fraud and a crime in itself under California statutes. The Debtor knew that the bills referenced in the Complaint that Newport Superior issued to Plaintiffs for diagnostic and surgical procedures, including gastrointestinal procedures, were false and fraudulent because the patients did not have the symptoms or conditions represented, and the procedures were completely unnecessary and medically unjustifiable. The Debtor also established a successor clinic to Newport Superior at the same location called Harbor Multi-Specialty Surgery Center, which continued to commit the same fraud under a different name in order to try to escape detection
6 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 6 of FIRST CLAIM FOR RELIEF (Nondischargeability of Claims Pursuant to Section 523(a)(2)(a) of the Bankruptcy Code) 28. Plaintiffs repeat and reallege the allegations contained in paragraphs 1 through 27 above and incorporate the same herein by this reference. 29. Plaintiffs claims against the Debtor are of the kind specified in section 523(a)(2)(a) of the Bankruptcy Code. Specifically, the Debtor was an active and knowing participant in a fraudulent scheme pursuant to which the Debtor and his coconspirators submitted fraudulent claims for surgeries that were medically unnecessary and received money from Plaintiffs for medically unnecessary surgeries falsely disguised as medically necessary surgeries. In making payments on these claims, Plaintiffs justifiably relied on the false information provided by the Debtor and his coconspirators. The conduct was malicious and intentional. 30. By reason of the foregoing, Plaintiffs are entitled to a judgment determining that their claims against the Debtor are nondischargeable pursuant to section 523(a)(2)(a) of the Bankruptcy Code SECOND CLAIM FOR RELIEF (Nondischargeability of Claims Pursuant to Section 523(a)(6) of the Bankruptcy Code) 31. Plaintiffs repeat and reallege the allegations contained in paragraphs 1 through 30 above and incorporate the same herein by this reference. 32. Plaintiffs claims against the Debtor are of the kind specified in section 523(a)(6) of the Bankruptcy Code. Specifically, the Debtor and his coconspirators intentionally, willfully and maliciously engaged in the fraud set forth above and in the Complaint, and the Debtor knowingly and actively participated in the fraudulent scheme. The actions were done with the intent to harm Plaintiffs, with reckless disregard for Plaintiffs and without just cause or excuse. 33. By reason of the foregoing, Plaintiffs are entitled to a judgment determining that their claims against the Debtor are nondischargeable pursuant to section 523(a)(6) of the Bankruptcy Code. WHEREFORE, Plaintiffs pray for judgment against the Debtor as follows: A. On the First Claim for Relief, for a determination that Plaintiffs claims against the 5
7 Case 2:08-ap ER Doc 1 Filed 04/14/08 Entered 04/14/08 11:23:05 Desc Main Document Page 7 of Debtor are nondischargeable pursuant to section 523(a)(2)(a) of the Bankruptcy Code. B. On the Second Claim for Relief, for a determination that Plaintiffs claims against the Debtor are nondischargeable pursuant to section 523(a)(6) of the Bankruptcy Code. C. On all claims for relief, for costs of suit and such other and further relief as the Court deems proper Dated: April 14, 2008 PEITZMAN, WEG & KEMPINSKY LLP By /s/ David B. Shemano David B. Shemano -and- MARVIN WEXLER LAWRENCE C. FOX KORNSTEIN, VEISZ WEXLER & POLLARD LLP Attorneys for Plaintiffs and Creditors 6
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1 1 1 1 Laurence M. Rosen, Esq. (SBN ) THE ROSEN LAW FIRM, P.A. South Grand Avenue, Suite 0 Los Angeles, CA 001 Telephone: () - Facsimile: () - Email: lrosen@rosenlegal.com Counsel for Plaintiff UNITED
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HELFAND & HELFAND Andrew B. Helfand (AH-8277) Michael C. D Aries (MD-4888) 60 East 42nd Street, Suite 1048 New York, NY 10165 (212) 599-3303 Attorneys for Plaintiffs UNITED STATES BANKRUPTCY COURT EASTERN
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