Chiropractor Prosecuted for
False Billing for ALCAT Testing

Stephen Barrett, M.D.

Benjamin Darrow, D.C. 48, who practiced in Daly City, California, has pleaded "no contest" to insurance fraud and other charges related to an ineffective food allergy test that is not covered by insurance companies. The amended felony information accused Darrow of 15 counts of insurance fraud, 1 count of practicing medicine without a license, and 1 count of illegally charging for laboratory services [1].

The ineffective test—called the Antigen Leukocyte Antibody Test (abbreviated ALCAT or Alcat)—was launched in the mid-1980s by American Medical Testing Laboratories and is now marketed by Cell Sciences Systems Corp. of Deerfield Beach, Florida. The test analyzes the responses of the patient's white blood cells (leukocytes) when incubated with extracts of foods and other test substances. Proponents claim that the test can detect "intolerances" and that avoiding the alleged offenders can lead to improved health in various ways [2].

Although the ALCAT test has been available for more than 30 years, its use has not been established by scientific studies [3]. Blue Shield of California has summarized the research this way:

There is a lack of published research on the diagnostic accuracy of ALCAT; therefore, it is not possible to determine the sensitivity, specificity, and/or predictive value of the test compared with alternatives. A few low-quality studies have reported improvements in outcomes following the use of ALCAT, but it is not possible to determine whether these changes occurred as a result of the test itself, bias, variation in the natural history of the condition, and/or the placebo effect. The evidence is insufficient to determine the effects of the technology on health outcomes [4].

The prosecuting attorney's trial brief summarizes what Darrow did to get into trouble.

In February 2019, based on the same facts, California's Board of Chiropractic Examiners charged Darrow with unprofessional conduct [6]. The outcome is likely to be revocation of his license.

In May 2019, Darrow pleaded "no contest" to all 17 counts with which he had been charged. The plea agreement indicates that the maximum penalty that could be imposed is 76 months in prison, a fine of $1,771,243.80, a $10,000 restitution fund fine, and actual victim restitution of $885,621.90, plus investigative and court costs. The prosecutors have requested a maximum sentence of 4 years [7].

Other ALCAT-Related Cases

Several other peoples have gotten into trouble for improper billing for ALCAT tests.

In 2014, the San Diego District Attorney filed a criminal complaint charging Richard Loos, D.C., and his billing manager with insurance fraud, grand theft, and violations of allergy test, the antigen leukocyte antibody test, otherwise known as an 'ALCAT., based on his submission of claims to health care plans for the ALCAT test. Like those of Darrow, Loos's ALCAT claims failed to disclose that he had purchased the test and instead falsely indicated that he had actually performed the test in his office by identifying himself as the provider and using a procedure code for the test performance. The government also alleged that Loos had violated California's Section 655.5 by charging $7,250 for the ALCAT test even though he had only paid approximately $1,000 for each test. In 2015, Loos pleaded guilty to several of the charges, and received a one-year suspended jail sentence, and was ordered to pay restitution of $221,374. In 2016, and surrendered his chiropractic license.[8].

In 2015, Louisiana chiropractor David Lee Killen pleaded guilty to one count of healthcare fraud for billing insurance companies from 2009 through 2012 for chiropractic care, equipment, and testing he never performed. Killen, who owned Back on Track Clinic in Bogalusa, admitted using the identification numbers of physicians who no longer worked for his clinics to submit bills to insurers for work they did not perform. The billings included ALCAT tests, for which he charged insurance companies considerably more than he paid for the tests. Killen was sentenced to 44 months in prison to be followed by three years of supervised release. He was also ordered to pay restitution to five insurance companies [9].

In 2016, the State of California charged Edward A. Balbas, M.D., Jon Brunelle, D.C., and Brunelle's wife Alejandra Brunelle with felony insurance fraud that involved deceptive billing for ALCAT tests [10]. The trio did business as Corona Physical Medicine. Balbas pleaded guilty and is awaiting sentencing. The Brunelles are awaiting trial.

References

  1. Amended felony information. The People of the State of California vs. Benjamin Zimberoff Darrow. Superior Court of California, County of San Mateo. Case No. 16-NF-012720-A, filed, April 6, 2018.
  2. ALCAT Test overview. Cell Science Web site, accessed May 25, 2019.
  3. Wuthrich B. Unproven techniques in allergy diagnosis. Journal Investigational Allergology and Clinical Immunology 15:86-90, 2005.
  4. Antigen leukocyte antibody test. Blue Shield of California Policy 2.01.93, Dec 1, 2018.
  5. People's trial brief. The People of the State of California vs. Benjamin Zimberoff Darrow. Superior Court of California, County of San Mateo, Case No. 16-NF-012720-A, filed May 15, 2019.
  6. Accusation. In the matter of the accusation against Benjamin Zimberoff Darrow before the California Board of Chiropractic Examiners. Case No. 2018-12144, filed February 6, 2019.
  7. Plea agreement. The People of the State of California vs. Benjamin Zimberoff Darrow. Superior Court of California, County of San Mateo, Case No. 16-NF-012720-A, filed May 20, 2019.
  8. Stipulated surrender of license and order. In the matter of the accusation against Richard Loos before the California Board of Chiropractic Examiners. Case No. AC2016-1079, filed Aug 31, 2016.
  9. Bogalusa chiropractor sentenced for health care fraud. USDOJ news release, Aug 12, 2015.
  10. Felony complaint. The People of the State of California vs Edward Albert G. Balbas, Jon Brunelle, and Alejandra Brunelle. Superior Court of California, County of Riverside, Case No. RIF1604500, filed Sept 12, 2016.

This article was posted on June 8, 2019.

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