Sim Hoffman M.D. Acquitted of Comp Fraud After 10 Years of Litigation

Sacramento, CA - A sleep doctor was acquitted of conspiring to defraud insurance companies of about $7 million in workers' compensation claims, in a case that took about a decade to finally go to trial.

In May 2011, Sim Carlisle Hoffman M.D. was indicted on 884 felony counts alleging healthcare insurance fraud in violation of section 550. Hoffman was the owner of Advanced Professional Imaging (API), Advanced Management Services (AMS), and Better Sleeping Medical Center (BSMC) in Buena Park, and prosecutors accused him of running a "medical mill" for the sole purpose of insurance over-billing without providing any legitimate treatment to patients.

Orange County District Attorney at the time, Tony Rackauckas, and then California Insurance Commissioner Dave Jones originally announced the hundreds and hundreds of charges against Hoffman, BSMC neurologist Dr. Michael Heric of Malibu, Hoffman’s administrator Beverly Mitchell of Westlake Village and API billing collector Louis Santillan of Chino Hills.

The 2011 indictment was ultimately dismissed in 2013 on the ground that the prosecution had failed to provide exculpatory evidence to the grand jury.

Rather than proceed by indictment, in January 2014, the prosecutors filed a felony complaint against Hoffman. The complaint alleged 159 counts of insurance fraud. One year and one-half later - after four amendments and two demurrers - the people filed a fifth amended complaint, alleging violations of section 550, subdivision (a)(5) (33 counts), subdivision (a)(6) (135 counts), and subdivision (a)(7) (one count).

The preliminary hearing began on September 1, 2015, and ended on November 23 of that year. The resulting transcript spanned over 2,300 pages. Over 53,000 pages of documentary evidence was submitted. During the preliminary hearing, the complaint was amended again. This final amendment contained 102 counts alleging a violation of section 550, subdivision (a)(6), and one count alleging a violation of subdivision (a)(5). Defendant was held to answer on all 103 counts.

Following the 2015 preliminary hearing, prosecutors filed an amended information containing 121 counts: 120 counts of violating section 550, subdivision (a)(6), and one count of violating subdivision (a)(5). the amended information, for each count, included both patient names and references to the preliminary hearing exhibit numbers containing the evidence relevant to the particular offense.

In 2017 The case was reviewed by the court of appeal in the published case of Sim Carlisle Hoffman v The Superior Court of Orange County 16 Cal.App.5th 1086, 224 Cal.Rptr.3d 818. Hoffman lost his appeal at this point.

Moving on to this year, following weeks of testimony, Orange County Superior Court Judge Richard King granted a motion in February 2022 dumping all but one of the 121 felony charges in the case.

After completion of the testimony Jurors deliberated for about a day before acquitting Dr. Sim Carlisle Hoffman of the last single count of conspiracy to commit insurance fraud.

Source: WorkCompAcademy.com

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