Surgeon Will Stand Trial on Insurance Fraud Counts

SANTA ANA —  A longtime Santa Ana orthopedic surgeon was ordered to stand trial Tuesday on 67 counts of insurance fraud and perjury for allegedly overbilling 21 different insurance companies.

Dr. Edward H. Boseker, a former board member of the Tustin Unified School District, entered a not-guilty plea at his arraignment in Orange County Superior Court.

Between October 1993 and February 1996, Boseker allegedly overcharged the insurance companies by billing for two or more hours of “face to face” time spent with some 22 patients who had filed worker’s compensation insurance claims, when he had actually spent less time with them, according to the complaint.

Ronald G. Brower, Boseker’s lawyer, said the charges were made to the district attorney’s office by a woman who “testified that she was a disgruntled employee who was under psychiatric care” at the time.

Brower said Boseker’s “position is he didn’t commit any crime.” He noted that at Boseker’s preliminary hearing, 24 insurance adjusters testified and “there wasn’t a single one of them who understood the billing procedures that are set out under the [California] regulations.”

Brower said “the total alleged loss is approximately $50,000, and this is stretching it to call it alleged overbilling.”

But Deputy Dist. Atty. Doug Brannan said, “Two employees testified at his preliminary hearing and others will testify at the trial” about the allegedly excessive charges.

Boseker was bound over for trial last month by Municipal Judge James A. Stotler after a 15-day hearing.

Evidence presented at that hearing indicated most of the patients had been referred to Boseker by lawyers to produce medical-legal reports required by the worker’s compensation system, Brannan said.

These reports guide the state worker’s compensation judges who ultimately determine the extent of a claimant’s disability and the amount of compensation the worker receives.

In most instances, the worker’s compensation system permits physicians to submit bills based upon the amount of time actually spent examining a patient, reviewing the patient’s medical files and preparing the report.

Twenty-five of the charges involve alleged material misstatements by Boseker on the worker’s compensation forms, which require doctors to declare under penalty of perjury that the information they provide is true.

Another 15 charges involve allegations that Boseker billed for two or more hours that he spent “reviewing records” of the patient when he had not, Brannan said, and five involved the number of X-rays taken.

Boseker did not return a call for comment.

A trial date will be set on Friday.