CALIFORNIA—Castro Valley orthopedic surgeon, Douglas J. Abeles, M.D., was a part of the insurance fraud scheme that took place at his East Bay business office. An arrest warrant was issued on his name, obtained by the Alameda County District Attorney’s Office. California Department of Insurance and Alameda County District Attorney’s Office together conducted an investigation, following which, he has been charged with 31 felony offenses.
As per Medical Board records, he is not board certified in any specialty. He also does not have any disciplinary actions against him as per the records. He presently has unfettered rights to practice medicine. Abeles has a specialization in Spine Surgery, Sports Medicine and General Orthopaedics, according to his website drabeles.com.
He completed his fellowships at Georgetown University, at Virginia Sports Institute and also at USC-Rancho Los Amigos Spine Surgery in the year 1995. He completed his residency in 1993 at the renowned New York Medical College. He had also served spine and pediatric services at the Hospital for Joint Disease in the year 1992.
The authorities have filed a criminal complaint against Abeles and his office manager, Gabriela Cuevas, that alleges that he had fraudulently and falsely billed insurance companies for medical services that were not provided in reality, for several years. Abeles, had been running an orthopedic medical practice in Castro Valley and four other medically-related businesses from his Castro Valley-Hayward border office. These businesses used to conduct drug testing urine analysis for medical offices on contract basis. It was through this business that he has been alleged of fraudulently billing insurance companies for lab reports.
Abeles had formed Physicians RX Network, Inc. in the year 2005 in a different location than his medical office. PRXN had contracts with physicians to dispense prescription drugs, including compound creams. They billed the insurance companies for these drugs, on behalf of the physicians. Abeles opened up the Urine Analysis business, forming Redwood Laboratory Management and Redwood Laboratory Associates in late 2010. RLM had contracts with physicians to perform urine drug testing on patients. They billed insurance companies on behalf of the physicians for the drug testing. PRXN and RLM used to operate in the same office and the two businesses were being overlapped and shared. Abeles also formed another business, PRXN Toxicology, LLC. in May of 2011. Abeles hired Larry Davis to be the Chief Operating Officer, Gregg Gorski to be the sales representative and Roxanne Cecot to be the billing supervisor at PRXN. All three had complained about overbilling insurance companies for prescription drug compounds. Roxanne Cecot came to know that Douglas Abeles had told the receptionist and another PRXN employee to manually increase the prices and override the billing software at PRXN. When Roxanne Cecot told Abeles about the billing improprieties, he said that they’d screw the insurance companies until they catch on. Abeles allegedly sent an email that stated that if any employee implies any wrongdoing to anyone, they will be fired immediately on grounds of insubordination.
One document that was allegedly sent to insurance companies was called Urine Toxicology Review report and it stated that the physician who ordered the urine test, then spent forty five minutes reviewing medical records, that was submitted by PRXN for the physician’s review. This activity allegedly did not take place in reality and the billing was fraudulently generated. In March of 2013, court ordered a search to be carried out and Gabriela Cuevas’ work computer was seized during the same. Over 10,200 of these UTR’s were found to be stored in her computer.
Gabriela Cuevas was released on her own recognizance while Abeles posted $355,000 bail. Arraignment has been scheduled for Monday, November 3, 2014.