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Menifee doctor found guilty of insurance fraud

 

Last updated 10/6/2018 at 1:27pm



RIVERSIDE - A Menifee physician who billed insurance companies for bogus work and lied about his license status could face up to 18 years in state prison when he's sentenced next month.

Dr. Benjamin Gould Cox, 86, was convicted on Thursday, Oct. 4 by a Riverside jury of seven counts each of insurance fraud and perjury. He's slated to be sentenced on Nov. 13 before Riverside County Superior Court Judge Thomas Glasser at the Riverside Hall of Justice. Cox remains free on $30,000 bail.

According to the Riverside County District Attorney's Office, Cox committed the offenses while serving patients involved in workers' compensation insurance claims.

Prosecutors said that the defendant, who has been practicing medicine since the early 1960s and has been previously disciplined for professional violations, came to the attention of authorities after the California Department of Industrial Relations learned he had been fraudulently billing for "medical-legal reports'' tied to workers comp cases.

The reports are required by the state Workers' Compensation Appeals Board when a dispute arises between an injured worker and his or her insurer.

Cox was representing himself as a qualified medical evaluator, or QME, to insurance companies and creating reports to resolve non-existent disputes, according to the D.A.'s office. He sent QME reports to Berkshire Hathaway, Employers Insurance, The Hartford, Liberty Mutual, the State Compensation Insurance Fund, Zenith Insurance and Zurich Insurance, seeking a total $90,000 for reports that were never commissioned, prosecutors said.

The Department of Industrial Relations designates QMEs and confirmed to investigators that the doctor was not among its active designated reviewers, though years before he had been one. Cox continued to identify himself in statements to the California Medical Board as a QME, despite the lapse of his certification, resulting in acts of perjury, according to the prosecution.

The board in 2013 placed Cox on probation, restricting his practice, because of documented instances in which he had failed to appropriately diagnose and establish treatment plans for a number of patients, according to the California Department of Consumer Affairs.

Cox completed his probation in 2016. But last February, his license was suspended by the board in response to the filing of a criminal complaint containing the charges for which he was just convicted.

 

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