Newport Beach doctor accused of medical insurance fraud

SANTA ANA — Prosecutors on Monday identified a Newport Beach physician and three others as defendants in a grand jury indictment alleging $17 million in workers’ compensation insurance fraud.

The Orange County district attorney’s office and the California Department of Insurance released a grand jury transcript and a 181-page indictment listing 884 charges against Dr. Sim Carlisle Hoffman, 59, a radiologist from Newport Beach.

Also charged were Dr. Thomas Michael Heric, 74, of Malibu; Louis Umberto Santillan, 44, of Chino Hills; and Beverly Jane Mitchell, 60, of Westlake Village.

They and Hoffman are accused of billing insurance companies for more expensive and unnecessary procedures that were sometimes never performed.

“It is no secret that these types of fraud are resulting in higher insurance rates and hemorrhaging California businesses,” District Attorney Tony Rackauckas said. “We need to end these types of medical fraud mills … Let’s end unethical doctors, unscrupulous dealings and patients being treated like walking ATMs.”

Hoffman owned three medical facilities in Buena Park — Advanced Professional Imaging, Advanced Management Services and Better Sleeping Medical Center — and allegedly used them to overbill the city of Los Angeles and 18 insurance companies.

Hoffman and Mitchell, who served as the administrator in charge of insurance billing, were charged with 883 felony counts of insurance fraud and one felony charge of aiding and abetting the unauthorized practice of medicine. They face a maximum of 892 years in state prison, if convicted on all charges.

Heric, who worked as a neurologist, was charged with 296 counts of insurance fraud and felony aiding and abetting the unauthorized practice of medicine. He faces a maximum of 315 years in state prison if convicted on all charges.

Santillan, who worked as a bill collector, was charged with 141 felony counts of insurance fraud. He faces a maximum of 150 years in state prison, if convicted on all charges.

In 2001, the state’s Medical Board disciplined Hoffman for excessive billing and putting a patient through unnecessary radiology treatments.

Heric was previously convicted of felony federal fraud in 2008 and had his medical license suspended for 60 days.

All four defendants were released from custody after making bail and are expected to be back in court June 22 for their arraignment at the Central Justice Center in Santa Ana. Hoffman and Heric will also face a hearing on the revocation of their medical licenses at that time.