SANTA ANA, Calif. – A Beverly Hills surgeon and his girlfriend have been charged with stealing nearly $52 million in an elaborate insurance fraud scheme that involved hiring body brokers to pay patients at Southern California sober living homes to undergo medically unnecessary surgeries, medical testing, and other medical procedures. Four others have been charged in connection with the illegal operation.
Dr. Randy Rosen pleaded not guilty on July 2, 2020 to 88 felony counts in two separate cases in connection with recruiting and hiring numerous body brokers to find and pay patients to have medically unnecessary Naltrexone implant surgeries and cortisone shots.
Numerous insurance companies were then billed for these unnecessary procedures and were never informed of the fact that patients were being trafficked and paid for these procedures. Due to this massive scheme and conspiracy, the insurance companies were fraudulently billed approximately $600 million and paid out approximately $50 million dollars.
Rosen’s girlfriend Liza Visamanos, 41, of Los Angeles, pleaded not guilty on July 2, 2020 to 56 felony counts in two separate cases in connection with the scheme.
Rosen, 57, of Los Angeles, and Visamanos were arrested June 30, 2020 by the Orange County District Attorney’s Office on nearly $52 million warrants which equals the amount stolen as a result of the scheme.
A commissioner on Thursday reduced Rosen’s bail to $15 million in one case and $1 million in the other case. Visamanos’ bail was reduced to $3 million in one case and $100,000 for the second case. Both defendants will be on GPS monitoring. VIsamanos will have to surrender her passport. Rosen’s passport was already surrendered.
In addition to submitting patients to medically unnecessary procedures, it is alleged that Dr. Rosen also required the patients to undergo unnecessary drug tests which he sent to Lotus Laboratories, which is owned by his girlfriend, for testing. California law prohibits such referrals where the physician or his immediate family has a financial interest with the person or entity receiving the referral. It is alleged that Lotus Laboratories fraudulently billed at least 22 different insurance providers more than $3 million.
Robert Mellon, 52, of San Diego, Thomas Douglas, 29 of Playa del Rey, Shea Simmons, 28, of Jeanerette, Louisiana, and Patrick Connolly, 28, of Los Angeles, also face felony charges for their involvement in the scheme.
All the defendants will have to establish that any money used to pay for bail comes from a legitimate source.
“Vulnerable sober living patients who were trying desperately to battle their addictions were treated like human guinea pigs just to make a buck,” said Orange County District Attorney Todd Spitzer. “I refuse to allow these body brokers to exploit and traffic human beings as part of a sick and twisted plot to line their own pockets. This prosecution is a testament to the dedicated work of our prosecutors and our Bureau of Investigation to hold these real-life Frankensteins accountable.”
Summary of Charges and Defendants – Health Insurance Fraud Cases
As part of the Health Insurance Fraud scheme, Dr. Rosen, (Case No.20CF1682), is charged with eight counts of Creating Documents For Purposes of Submitting False or Fraudulent Insurance Claims, eight counts of Submitting False or Fraudulent Insurance Claims, eight counts of Withholding Material Facts on Insurance Claims, eight counts of Conspiracy to Commit Unlawful Patient Referrals, and sixteen counts of Money Laundering. He is also charged with White Collar Crime Enhancements as the amount of loss exceeded $500,000 and a crime-bail-crime enhancement for committing additional crimes while released on bail on his previous and still active insurance fraud case in People v. Randy Scott Rosen (Case No. 16CF1363). If convicted on all counts, he faces a maximum of 84 years and eight months in state prison.
Liza Vismanos, (Case No. 20CF1685), is charged with eight counts of Creating Documents For Purposes of Submitting False or Fraudulent Insurance Claims, eight counts of Submitting False or Fraudulent Insurance Claims, eight counts of Withholding Material Facts on Insurance Claims, and eight counts of Conspiracy to Commit Unlawful Patient Referrals. She is also charged with White Collar Crime Enhancements as the amount of loss exceeded $500,000. If convicted on all counts, she faces a maximum of 36 years and four months in state prison.
Thomas Douglas, (Case No.20CF1684), is charged with eight counts of Creating Documents For Purposes of Submitting False or Fraudulent Insurance Claims, eight counts of Submitting False or Fraudulent Insurance Claims, eight counts of Withholding Material Facts on Insurance Claims and eight counts of Conspiracy to Commit Unlawful Patient Referrals, and twenty-seven counts of Money Laundering. He is also charged with White Collar Crime Enhancements as the amount of loss exceeded $500,000. If convicted on all counts, he faces a maximum of 68 years and eight months in state prison.
Robert Mellon, (Case No. 20CF1683), is charged with eight counts of Creating Documents For Purposes of Submitting False or Fraudulent Insurance Claims, eight counts of Submitting False or Fraudulent Insurance Claims, eight counts of Withholding Material Facts on Insurance Claims and eight counts of Conspiracy to Commit Unlawful Patient Referrals. He is also charged with White Collar Crime Enhancements as the amount of loss exceeded $500,000. If convicted on all counts, he faces a maximum of 36 years and four months in state prison.
Shea Simmons, (Case No. 20CF1681), is charged with eight counts of Creating Documents For Purposes of Submitting False or Fraudulent Insurance Claims, eight counts of Submitting False or Fraudulent Insurance Claims, eight counts of Withholding Material Facts on Insurance Claims, eight counts of Conspiracy to Commit Unlawful Patient Referrals and eleven counts of Money Laundering. He is also charged with White Collar Crime Enhancements as the amount of loss exceeded $500,000. If convicted on all counts, he faces a maximum of 45 years and four months in state prison.
Patrick Connolly, (Case No. 20CF1677), is charged with eight counts of Creating Documents For Purposes of Submitting False or Fraudulent Insurance Claims, eight counts of Submitting False or Fraudulent Insurance Claims, eight counts of Withholding Material Facts on Insurance Claims and eight counts of Conspiracy to Commit Unlawful Patient Referrals, and nine counts of Money Laundering. He is also charged with White Collar Crime Enhancements as the amount of loss exceeded $500,000. If convicted on all counts, he faces a maximum of forty-five years and four months in state prison.
Summary of Charges and Defendants – Workers’ Compensation Fraud Cases
As part of the Workers’ Compensation scheme, Dr. Rosen is charged with twenty-four counts of Withholding Material Facts on Insurance Claims and seventeen counts of Creating Documents for Purposes of Submitting False or Fraudulent Insurance Claims. Vismanos is charged with twenty-four counts of Withholding Material Facts on Insurance Claims. The couple was also charged with the aggravated white collar crime enhancement for losses exceeding $100,000 and $500,000. Dr. Rosen is charged with a crime-bail-crime enhancement pursuant to Penal Code Section 12022.1(b) for committing additional crimes while released on bail on his previous and still active insurance fraud case in People v. Randy Scott Rosen (Case No. 16CF1363).
As part of the Workers’ Compensation Fraud case, Dr. Rosen is facing a maximum of 51 years in state prison if convicted on all charges.
As part of the Workers’ Compensation Fraud case, Liza Vismanos is facing a maximum of 31 years in state prison.
Deputy District Attorney Vincent Marinaccio of the Insurance Fraud Unit is prosecuting defendants Dr. Rosen and Vismanos’ workers’ compensation fraud cases.
Deputy District Attorney Jim Bilek of the Insurance Fraud Unit is prosecuting defendants Dr. Rosen, Vismanos’, Douglas’, Simmons’, Connolly’s, and Mellon’s health insurance fraud cases.
