Unlicensed Doctor Convicted of Insurance Fraud and Other Crimes.

• Author: Zalma, Barry
• Position: [ON MY RADAR]

* After Patrick E. Usanga (Usanga) was convicted for many crimes of fraud he appealed his convictions unsuccessfully and then filed Post Conviction Relief Act motion to set aside the conviction in Commonwealth of Pennsylvania v. Patrick E. Usanga, J-S29031-20, No. 1946 EDA 2019, Superior Court of Pennsylvania (July 13, 2020).Usanga appealed pro se (proving the old saying that he had a fool for an attorney) from the order denying his first petition filed pursuant to the Post Conviction Relief Act (PCRA) in the Court of Common Pleas of Philadelphia County (PCRA court).

FACTS

The court took the following factual background and procedural history from our independent review of the record, this Court's August 16, 2017 opinion, and the PCRA court's December 16, 2019 opinion. A previous panel of this Court set forth the relevant factual background of this matter as follows: [Usanga], a Nigerian-born United States citizen [,] obtained a medical degree from the University of Guadalajara in Mexico in 1982. He took the board examination to be a licensed medical doctor in Pennsylvania several times in the 1980s and [19]90s, but did not pass. On May 19, 2009, he filed the necessary paperwork to incorporate a health care facility, Northeast Behavioral Medicine, Inc., with himself as the sole officer of the corporation.... He applied for and received a license to operate a psychiatric clinic soon after incorporation. At all times during the period of time Northeast Behavioral Medicine was in business and seeing patients, [Usanga] was the only provider at the facility.

During that period, he saw patients for various mental health and substance abuse issues. Several of his former patients testified that he told them that he was either a psychologist or a psychiatrist. As a result of the services provided by the Appellant, he billed various insurance companies including Aetna and Blue Cross, for his services. Usanga billed Aetna $24,950.00 and received $5,036.38 as an out-of-network provider. Blue Cross paid a total of $15,763.84 to him. That money was deposited in a TD Bank account owned by Usanga. Concurrently to the period of time that Usanga was operating Northeast Behavioral Medicine, he was also collecting unemployment compensation and Social Security disability benefits. However, Usanga was not entitled to unemployment benefits once he incorporated his business and became self-employed. The Pennsylvania Department of Labor determined that the...