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 « Scammers Act under Coverof Tax Refund|Main| Truck Jumps Curb, SplattersThree Pedestrians onSidewalk»
Auto Insurance Fraud DoctorsSentenced
Way back in March, 2005,Manhattan District AttorneyRobert M. Morgenthauindicted fifteen people, including four doctors, a dentist, a psychologist, and anacupuncturist, oncharges of participating in an insurance scam in which insurance companies and the N.Y.C.Transit Authority were over-billed for No-Fault insurance charges,for medical care arising out of automobile accidents. Alsoindicted were a medical billing company, two health careclinics that were also professional medical corporations andthree other professional medical corporations.The defendants were charged with insurance fraud, grandlarceny, attempted grand larceny and scheme to defraud.An examination of financial records revealed that theclinics billed more than sixty insurance carriers for millionsof dollars in claims over a ten year period.Abraham Pustilnik, a/k/a Abraham Post, and his mother,Isabella Pustilnik, a/k/a Isabella Post, used their ownershipof a medical billing company and their control of medicalclinics and professional corporations to defraud insurancecarriers who paid out claims believing that the clinics wereproviding legitimate services. They also cheated patientsby providing them with inadequate or medicallyunnecessary procedures.The D.A.’s investigation revealed that the two Pustilniks,neither of whom is a doctor, operated Premier MedicalCare and Omni Medical Care. They also Owned EmpireMedical Management, a medical billing company. Inaddition, they were the covert owners of five medicalcorporations: both medical clinics, Premier Medical andOmni Medical, as well as University Psychological, FocusAcupuncture and Optimal Healthcare Medical.The investigation also revealed that the two Pustilniksused licensed professionals as 'fronts' or "Docs-in-the-Box"for the professional corporations to disguise theirownership of the clinics. New York State law specificallyprohibits the "corporate practice of medicine" and does notallow a medical practice or clinic to be directly owned byanyone other than medical doctors.
 
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Generally the defendants submitted three types of fraudulent claims:Billings for services in whichthe defendants claimed thatthey had seen and treatedpatients on dates when theyhad not.Billings in which thedefendants "up coded" - i.e.,claimed that a particularprocedure or doctor's visitlasted longer than it actuallydid to obtain a higherreimbursement rate.Billings in which thedefendants ordered medicallyunnecessary testing andtesting that was notperformed; two doctorsordered numerousunnecessary MRIs for the andone doctor ordered a brainMRI for a patient who onlycomplained of lower back pain.The Pustilniks were believed to have spent the proceeds of their crimes on a Central Park West co-op, luxury cars anda $2 million property in upstate New York’s Catskillmountain area.So now let’s update our report.This past November, 2007, two of the medical doctorsswept up in this bust were convicted in Manhattan onfraud, grand larceny and assorted other charges .Yesterday (February 11, 2008) the two medical doctorsswept up in by the Manhattan District Attorney weresentenced to prison. Dr. Victor Basbus, a neurologist, wassentenced Monday to two to six years in prison, while Dr.Gerardo Yanayaco, an internist, will serve up to 10 monthsin jail.
Commentary:
If you have an accident case and treatedat one of these "dirty" clinics, your case will usually beworthless. The prosecutors have your medical recordsburied somewhere. And you can’t hardly have a doctortestify in court after a felony conviction. Also, theinsurance companies know where these places are, sogood luck getting them to pay you a fair settlement. Soplay it clean and steer clear of these places, some of whichmay offer you money to be a patient. See myfree specialreport on dirty doctors. Also, I touch on this subject in myfree book:
Good Lawyers Don’t Call You First .
From: New York attorney Gary E. Rosenberg (personalinjury and accident attorney and lawyer; serving BrooklynQueens Bronx)
Posted by Gary E. Rosenberg on February 12, 2008 7:37 PM |
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