U.S. District Judge Kenneth M. Karas has ordered Middletown chiropractor James Spina to pay $9,760,555 in restitution as part of a criminal case in which Karas sentenced Spina last month to 9 years in prison for conspiracy to commit mail fraud.
Spina, 63, ran the Dolson Avenue Medical clinic in Middletown, providing pain management and rehabilitation services. But he also secretly ran eight other corporations and billed Medicare and private insurance companies for tens of millions of dollars in false medical claims, according to court records.
Spina agreed in a plea deal that he was responsible for $3.5 million to $9.5 million in losses to health care insurers. He personally earned $9.3 million during the 7-year scheme, according to prosecutors.
“Everything about the practice, from its corporate structure to its billing practices, was fraudulent,” federal prosecutors said in a sentencing memorandum.
From 2011 through late 2017, the Spina companies billed for unnecessary medical procedures, for services never provided, and for services previously billed.
Spina registered his clinics in the names of medical doctors to conceal his control and ownership, circumventing state law that requires only licensed physicians to own and operate medical practices.
The government depicted Spina as concerned more about money than patient care. A doctor working for Spina performed lucrative but high-risk facet injections, for example, despite no formal training in the procedure.
One patient got so sick that she had to go to an emergency room. Another passed out after an injection in his neck.
Spina, according to prosecutors, continued to encourage the doctor to inject patients. In March 2017, a woman passed out after the procedure and died several days later. The medical examiner concluded that the cause of death was complications of brain injury due to cardiopulmonary arrest following a cervical facet injection.
“Spina was the mastermind of a long-running, sophisticated conspiracy which appears to have caused extreme financial harm,” according to a sentencing report cited by prosecutors, “and most significantly medical malpractice, some of which resulted in physical suffering, including one case that is linked to death.”
Sentencing is pending against Spina’s brother, Jeffrey Spina, a chiropractor; sister, Kimberly Spina, an administrator; and Andrea Grossman, a bookkeeper, all of whom have pleaded guilty to criminal charges.
Judge Karas ordered Spina on May 21 to make installment payments while in prison, and if he still owes money after his release, to pay 10% of his monthly gross income. His obligation would end 20 years after he is released from prison.
But according to a preliminary forfeiture order also issued on May 21, “the proceeds traceable to the offense charged ”¦ cannot be located.”
