Quid-pro-Quo uncovered between car-accident victims and healthcare practitioners

A Hudson County man orchestrated the insurance-fraud scheme

Cash payments were received from healthcare providers.
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Cash payments were received from healthcare providers.

A Hudson County man has admitted to participating in a car-accident scheme in which healthcare practitioners fabricated or exaggerated crash victims’ injuries, U.S. Attorney Craig Carpenito announced.

These fabricated injuries were created to support fraudulent insurance claims to Personal Injury Protection (PIP) insurance plans for medically unnecessary services.

Luis Aguirre, 59, pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court to an information charging him with one count of conspiracy to commit healthcare fraud.

It is not clear which Hudson County city Aguirre is from.

According to the U.S. Attorney’s Office, Aguirre’s participation in the conspiracy caused an estimated loss to PIP insurance plans of more than $250,000, while the total loss caused by the conspiracy exceeded $3.5 million.

An auto body shop in WNY

Aguirre helped to orchestrate a vehicle-accident scheme in Bergen County and Hudson County by acting as a “runner” who identified and recruited accident victims to the scheme.

After being recruited, the victims were introduced by Aguirre to various chiropractors, medical imaging centers, and others, who billed PIP insurance plans for medically unnecessary services, according to the U.S. Attorney’s Office.

Aguirre and an employee from an auto body shop in West New York, Individual-1, identified and recruited individuals from the area who had been in car accidents.

According to the U.S. Attorney, the two would find the vehicle-accident victims through word-of-mouth in the community and through relationships with local healthcare providers.

Aguirre paid Individual-1 a sum of money for each accident victim that Individual-1 helped identify and recruit to the scheme. Individual-1, in turn, paid accident victims for participating in the scheme.

As part of the scheme, Aguirre also ensured that the victims had filed police reports to support subsequent insurance claims.

Aguirre then directed the accident victims to visit specific healthcare providers to obtain medically unnecessary exams and services. According to the U.S. Attorney’s Office, these services included X-rays and MRIs, for fake or exaggerated injuries that they supposedly suffered during the vehicle accidents.

Aguirre was paid approximately $500 in cash by the healthcare providers for each accident victim that he delivered. Healthcare providers submitted insurance claims to PIP insurance plans on behalf of the accident victims.

Individual-3

On Sept. 25, 2018, an individual from North Bergen, known as Individual-3, was involved in an vehicle accident in Elizabeth.

U.S. Attorney Carpenito stated that based on a police report of the incident, the accident was minor. Individual-3 was rear-ended by another car when both were stopped at a red light.

According to the police report, Individual-3 refused medical treatment at the scene, stating that Individual-3 would seek separate medical attention. At the time of the accident, Individual-3 had an automobile insurance policy through Auto Insurer-1, which included PIP coverage.

Aguirre learned from Individual-1, the WNY auto body shop employee, that Individual-3 was willing to participate in the scheme in exchange for cash payment. According to the U.S. Attorney’s Office, Aguirre directed Individual-3 On Oct. 12, 2018 to visit the proprietor of an MRI Center in Rochelle Park, known as Individual-2.

Individual-3 agreed to the plan and visited the MRI Center, where Individual-3 underwent a series of medically unnecessary X-rays. On Oct. 16, 2018, the MRI Center billed Individual-3’s PIP insurance policy.

As a result of his participation in the scheme, Aguirre faces a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for July 14.

Carpenito credited special agents of the Department of Labor – Office of Inspector General (DOL-OIG) under the direction of Special Agent in Charge Michael C. Mikulka and special agents of the FBI under the direction Special Agent in Charge Gregory W. Ehrie in Newark with the investigation leading to the guilty plea.

The government is represented in this case by Assistant U.S. Attorney Jason S. Gould of the Health Care Fraud Unit at the U.S. Attorney’s Office in Newark. Defense Counsel is named as John Lynch Esq. from Union.

For updates on this and other stories, check www.hudsonreporter.com and follow us on Twitter @hudson_reporter. Daniel Israel can be reached at disrael@hudsonreporter.com.