--The affiant[s are] Detective Peter McAfee and Detective Barry
McCooley of the Insurance Fraud Task Force. They report that
they received an anonymous tip from an individual indicating that
the defendant in this case, Mr. Ziegler, had been submitting
bills for services that were not performed.
The caller also reported that at one point the defendant
was in jail and the practice continued running without his
supervision.
Based on that an investigation was initiated, You[r] Honor,
on August 5th of 2008. The Detectives determined that the
defendant was arrested for reckless endangerment and as a
result of that he spent some time in Lehigh County Prison.
The investigation further determined that while the
defendant was incarcerated, particularly in the dates of January
23rd, January 27th, January 29th of 2009, as well as January 31st
of 2009, the defendant had submitted bills or had his practice
submit bills for doctor examinations that had occurred on those
dates.
Because he was incarcerated it was determined that doctor
exams could not have been performed, based on his location at
that point in time. Detectives further conducted an undercover
operation where 13 appointments were made for treatment at
Ziegler Chiropractic.
Detectives working in an undercover capacity and
audiotaping the interactions that occurred at the Ziegler
Chiropractic Clinic determined that doctor's exams were billed for
approximately well, actually ten of the visits made by the
undercover officers when, in fact, doctor's exams were not
performed and compensation for that activity was submitted to
State Farm Insurance, Infinity Insurance, Nationwide, [and]
Titan AIG for those services that were in fact
not rendered.
--His chiropractic license was not only an expected collateral consequence of
his fraud conviction, to the extent that he believed he could circumvent the
State Board of Chiropractic’s imminent determination and continue operating
a clinic, that misapprehension of the law did not undermine the validity of
the plea agreement.
--The two (Dean K Ziegler and his attorney) discussed at length the probability
that Appellant would lose his chiropractic license, and Appellant suggested
relocating the practice to the Caribbean or seeking licensure in Texas.
--In fact, in light of the strength of the Commonwealth’s insurance fraud case
and Appellant’s inability to afford an expert to present a positive interpretation
of his billing scheme, the reality of Appellant losing his license following his
conviction was so obvious, the chosen trial strategy was to delay the case and thereby
extend Appellant’s ability to continue to practice as long as possible.
--Attorney McGogney further explained that the Commonwealth had overwhelming
evidence of the fraudulent billing, including the testimony of undercover investigators
who were examined at Appellant’s office on one occasion but were charged for
multiple procedures and examinations that were not performed.
--The court announced, “Whatever little machinations were going on with you trying to
still continue to practice, when you have an insurance fraud conviction
against you, is not relevant to whether or not the plea was knowing, intelligent and
voluntary. It’s just not. And until I see some case law that says otherwise, this
[argument] is approaching ridiculous.”
--Attorney McGogney believed that the testimony presented by those witnesses would
be sufficient to convict Appellant, particularly when Appellant was unable to present
an expert to dispute the Commonwealth’s expert testimony regarding the billing codes.
--Moreover, Attorney McGogney met with the insurance fraud investigators and learned
that the Commonwealth was considering amending the criminal complaint to level
several additional charges stemming from its investigation of Appellant’s
billing practices.
--Attorney McGogney believed that the plea agreement was the best that Appellant
could attain under the circumstances and he did not want to needlessly annoy
the prosecution to obtain an inconsequential piece of evidence.
