FAIRFIELD, Conn. -- A Fairfield man who lost his medical license was sentenced to two years in federal prison for his role in an insurance fraud scheme and a conspiracy to illegally distribute prescription narcotics, according to the U.S. attorney for Connecticut.
Francisco R. Carbone, 56, was sentenced Friday by U.S. District Judge Stefan R. Underhill in Bridgeport. Carbone's prison term will be followed by three years of supervised release.
Carbone, who was paid $434,529 for participating in the scheme, also was ordered to pay that amount in restitution to the insurance carriers.
This matter stems from “Operation Running Man,” a 14-month undercover fraud investigation headed by the FBI.
According to court documents and witness testimony, Carbone had been licensed to practice medicine and worked as a sole practitioner in Bridgeport. In March 2005, his license to practice medicine was revoked by Connecticut.
Between December 2006 and February 2010, he conspired with attorney Joseph Haddad and Dr. Marc Kirshner, who owned and operated two chiropractor offices in Bridgeport and one in Stamford, to defraud insurance companies.
They exaggerated the auto accident injuries of Haddad’s clients to justify monetary settlements with the insurance companies.
As part of this scheme, they fabricated medical records, prescribed unnecessary pain medication, performed unnecessary chiropractic treatment, ordered and billed for diagnostic tests of questionable medical value, and overstated injuries or permanent partial disabilities that allegedly were caused by the accidents.
Haddad instructed his clients to see Carbone, who both Haddad and Kirshner knew was an unlicensed doctor. Carbone enlisted James W. Marshall Jr., a licensed doctor of osteopathic medicine in Monroe, to write prescriptions for oxycodone, hydrocodone and other narcotics for his patients, even if the medication was not needed.
Carbone also fabricated medical records, including the clients’ injuries and medical condition. The fabricated reports were given to Haddad, who provided them to the insurance carriers in support of settlements.
In addition, Carbone, Haddad and Kirshner engaged in a scheme to defraud Connecticut by providing fraudulent settlement statements to the state.
Carbone and Kirshner, at Haddad’s request, regularly kicked back a portion of their medical fees to Haddad’s clients.
More than 10 insurance carriers lost a total of more than $1.7 million as a result of this fraud scheme.
On July 19, 2011, Carbone pleaded guilty to conspiring to commit mail fraud to defraud insurance carriers, conspiring to commit mail fraud to defraud Connecticut, making a false statement relating to health care matters, and conspiring to distribute controlled substances outside the scope of the usual course of professional practice.
Carbone's criminal history includes federal convictions in 1999 for violating the Medicare/Medicaid anti-kickback statute and for filing a false federal tax return, for which he was sentenced to four months of imprisonment. In 2002, he was sentenced to an additional 13 months of imprisonment for violating the conditions of his supervised release.
Haddad, Kirshner, Marshall and three other chiropractors pleaded guilty in the scheme. On July 10, Haddad was sentenced to 51 months in federal prison. Kirshner and Marshall await sentencing.