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Insurance fraudsters steal R2bn

2012-03-01 10:42

FRAUD IN THE WARDS: The US is headed for a landmark case against fraudulent doctors and lawyers who coached 'clients' to fake injuries.

NEW YORK - Three-dozen people, including doctors, lawyers and 'patients', have been charged with scheming to defraud vehicle insurers out of more than $279-million in accident benefits.

Federal and New York City investigators said the defendants took part in a "medical fraud mill" involving bogus clinics in and around New York City that billed insurers for unnecessary or non-existent treatments.

They said the ring was designed to exploit New York's "no-fault" auto insurance law which requires vehicles registered in the state to carry insurance that lets drivers and passengers obtain up to R373 000 for accident injuries, regardless of blame.


Several of the defendants are of Russian descent, 35 live in New York or New Jersey.

Authorities called the criminal case the largest involving no-fault vehicle insurance fraud and the first of its kind to allege violations of the federal Racketeer Influenced and Corrupt Organizations Act (RICO), a law often used to fight organised crime.

They estimated that the equivalent of R844-million was lost in the scheme which began around 2007. Ten doctors and three lawyers were among those charged. The indictment was unsealed Wednesday in the US District Court in Manhattan.

US attorney Preet Bharara said: "Today's charges expose a colossal criminal trifecta, as the fraud's tentacles simultaneously reached into the medical system, the legal system and the insurance system, pulling out cash to fund the defendants' lavish lifestyles."

Vehicle insurers consider New York one of the most difficult markets in which to profit, in part because of the no-fault law.

At a news media conference in Manhattan, Bharara said "pretty much every" insurer in New York's no-fault program was a target of the fraud. Wiretaps were also used in the investigation.


According to the indictment, defendants Mikhail Zemlyansky, who used aliases like "Russian Mike,nd Michael Danilovich, also known as "Fat Mike," directed one of the two main branches in the scheme, while defendants Yuriy Zayonts, also known as "KGB", and Mikhail Kremerman ran the other.

Investigators said doctors were paid to set up fake bank accounts and prescribe unnecessary procedures or treatments, such as MRIs, neck and back braces and five-day-a-week physical therapy sessions. Lawyers filed fake personal-injury suits to obtain additional awards and  defendants, known as "runners", got cash kickbacks for referrals and to coach patients on how to fake injuries.

Janice Fedarcyk of the FBI said: "The criminal enterprise, while it lasted, was obscenely profitable."

Raymond Kelly, New York City's police commissioner, said two of the "patients" in the scheme were in fact undercover New York City police officers. "Our undercover officers were treated like thousands of other 'patients' receiving therapy, tests and medical equipment they didn't need."

All 36 defendants were arrested on Wednesday. Thirty-five were expected to be arraigned in Manhattan on Wednesday. The 36th lives in Duluth, Minnesota, and was expected to appear in court there on Thursday.

Each defendant faces a maximum of 30 to 70 years in prison if convicted.

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