Central Valley

Plea deal proposal outlines alleged multimillion health care fraud scheme in Merced

Horisons Unlimited Health Care on Main Street in Merced on March 2, 2018.
Horisons Unlimited Health Care on Main Street in Merced on March 2, 2018. mvelez@mercedsun-star.com

The embattled ex-CEO of a string of now-shuttered Merced-area health clinics that served thousands of low-income patients has signed an agreement to plead guilty to defrauding Medi-Cal of millions of dollars.

According to a copy of the document filed July 13 in U.S. District Court, Sandra Haar, former head of Horisons Unlimited Health Care, falsified medical and billing records and pocketed “kickback” payments to route work to a medical-testing laboratory dating back to at least 2014, according to documents filed in U.S. District Court.

Haar has been involved in a series of legal battles since March 2017. She was sued, fired and accused of misconduct that allegedly allowed her and her family to profit from the clinic.

The deal marks a significant turnaround for Harr who, in an interview earlier this year with the Sun-Star, denied any wrongdoing in connection with the eight clinics in Merced, Madera, Stanislaus and Mariposa counties.

“Ms. Haar has agreed to the government’s offer to plead guilty to these two crimes and to avoid the time and expense of grand jury proceedings, pretrial litigation, or jury trial, in order to move forward immediately to do all she can to rectify the legal problems and reduce the financial losses that resulted from the health clinics that she managed in the Merced area until she suffered a debilitating stroke in December 2016,” her attorney, Paul Wolf, said in an email.

Prosecutors, under the proposal, would agree not to press charges against three people connected to Haar: her daughter, Sara Price; her husband, Norman Haar; and Karen Tlemcami.

The U.S. Attorney’s Office declined to comment on the plea deal.

Wolf said in the email, “The government may make a motion to the judge for a sentence below the federal sentencing guidelines for Ms. Haar based on her cooperation with the government, but the government will not decide whether to make such a motion until shortly before Ms. Haar’s sentencing, which has not been calendared and will not occur for at least a few months. If that motion is made, it will be up to the judge whether to grant it or not.”

Haar could be required to pay millions of dollars in restitution. The final amount would be determined at a later date, according to the proposal.

A statement of facts filed last week — and signed by Haar and her attorney — includes numerous examples of alleged fraud.

Examples outlined in the document include allegations that Haar ordered patient records to be falsified or altered, made “misrepresentations” about services provided at clinic visits, ordered unnecessary tests and caused patients to return for repeated clinic visits that weren’t medically necessary.

Other examples outlined in the document say Haar juiced clinic numbers by causing staff members covered by Medi-Cal to be seen at the clinic to “increase numbers and reimbursements” when business was slow. Haar billed for visits with a licensed clinical social worker when “patients were seen instead by an unlicensed Christian counselor.” The document also states unlicensed foreign medical students were prescribing opioids at Horisons.

Haar also falsely billed Medi-Cal for office visits with licensed doctors “when patients instead were dispensed Suboxone, an opioid, in the parking lots of McDonalds and Rite Aid in Ziploc baggies,” the document states.

Haar also billed Medi-Cal when at least some patients “had their toenails clipped” and falsified medical records to say those patients had been treated for fungal toe infections, the document says.

The court document also outlines an alleged scheme in which Haar admits to accepting regular “kickbacks” during at least a three-year period. The document signed by Haar says she received about $1,000 per month to route lab work to a specific company.

“Haar pocketed the money and used it as spending money,” the document says. “Haar and the (lab’s) account executive kept their arrangement confidential and referred to the kickback as a donation for a church as they knew it violated the law.”

According to legal documents, 80 percent of patients Horisons served were insured through Medi-Cal and an estimated 46,000 patients were seen at the clinics last year.

A hearing in the case is set for Aug. 13 in U.S. District Court in Fresno.