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Fraud Soaking Drivers (New York Daily News)...a radiologist who was used for phony claims in reviewing magnetic resonance imaging exams failed to diagnose a brain tumor in the MRI of an accident victim, said investigators for Geico....- Mar 29 7:20 AM ET

Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)


Posted on: 03/29/2001

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Local - New York Daily News - updated 7:20 AM ET Mar 29
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Thursday March 29 07:20 AM EST "Fraud Soaking Drivers"

Fraud Soaking Drivers


Crooked doctors working through mob-backed medical mills are costing New York drivers $1 billion a year in insurance premiums and spiking no-fault rates to the highest in the nation.

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Consumer automobile insurance costs are soon expected to surpass New Jersey's, as accident scams and fraudulent medical bills deliver ever increasing payoffs, according to law enforcement authorities and industry experts.

The scams involve victims sideswiped by those in on the con, or collisions between vehicles driven by accomplices, according to Brooklyn Assistant District Attorney Jay Shapiro and investigators for insurers.

Shapiro said his ongoing probes have disclosed that Russian organized crime figures have funded many of the scams and medical mills.

The scams are designed to manipulate insurance companies into paying for treatments and tests that are unnecessary or never delivered.

Massages, aromatherapy, psychotherapy and whirlpool sessions are among those treatments; the tests include everything from audiology to X-rays in abundance.

For example, one Brooklyn acupuncturist billed Allstate $7 million last year for treatment of accident victims, according to investigators for the carrier. He said he was billing other insurers as well.

Doctors are paid off by the clinics, who use the physicians' names on boilerplate diagnoses, test requests and treatment prescriptions.

In one case, a radiologist who was used for phony claims in reviewing magnetic resonance imaging exams failed to diagnose a brain tumor in the MRI of an accident victim, said investigators for Geico.

The insurance companies pay the bogus claims, but the fraud costs each insured driver in the state between $75 and $115 a year, according to Bob Hartwig, an economist for the Insurance Information Institute.

Brooklyn has the highest fraudulent claim rate, with the Bronx second, Queens third and Manhattan fourth, according to studies by the institute.

Because of the fraud, Brooklyn drivers pay the highest overall premiums in the city, according to Hartwig.

"As of March 1, a 'clean' adult driver in Brooklyn carrying just the mandatory liability coverage and basic no-fault coverage will pay $3,100 a year," he said.

Insurance industry investigators blame the rampant fraud on a loophole in the state's no-fault laws: Health care providers have six months to submit claims to insurance companies, while the companies have 30 days to pay or deny a claim.

Accident victims under no-fault can build up $50,000 worth of medical bills, and in the scams, the phony victims assign their benefits to the medical mills.

The mill managers, in turn, "blow through the $50,000 cap" with a welter of bills submitted just under the six-month time limit, said Greg Serio, deputy superintendent of the state Insurance Department. "How do you review and track hundreds of tests and treatments six months after the fact, and do it in 30 days?" he asked.

Under state law, physicians must prescribe tests and treatment and own the clinics. But medical mills involved in the scams are owned by criminals who pay off doctors for their names on the bills, the clinic door and incorporation papers.

In one case, one doctor owned or was practicing out of 28 clinics, according to investigators.

The clinic managers run the scams with the help of runners who steer accident victims toward unnecessary treatment and direct the activities of phony victims.

The mills pay fake accident victims up to $1,000 for use of their insurance policy numbers in billing.

In some cases, identities and policy numbers are stolen or otherwise appropriated by the clinics.

"We had a case where we found that a man who had been dead for two years was involved in three separate accidents with a dozen accident 'victims,'" said Tom Sullivan, chief of Geico's special investigations unit. "In another case, we found a woman who had run up thousands of dollars of claims because of an accident, and she told us she was never in any accident and had never been to the clinic in question."

Once the policy numbers are obtained, the con artists tailor bills to take advantage of insurers' payment systems, according to prosecutors.

Injury fraud is a built-in cost of mandatory no-fault coverage in New York State. According to individual policies, it comprises 20% to 40% of the total premium. Studies by the institute show that injury claims in the state rose 32.1% in the year ending Sept. 30, more than twice the increase in second-place Florida.

"The increase is astonishing," said Hartwig, "and it's not explained by medical inflation, nor are we suddenly seeing as big an increase in the number of automobile accidents."

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