Massive insurance fraud scheme yields several indictments
Compliance Monitor, July 15, 2009
On July 8, New York Attorney General Andrew Cuomo announced the takedown of an elaborate fraud scheme that allegedly generated more than $1 million in profits, according to a Department of Justice (DOJ) release. Cuomo indicted 12 people and nine corporations implicated in the scheme.
In the release, Cuomo describes the plot, dubbed “The Levy Enterprise” as “a complex scheme that violated hospital patients’ privacy and may have driven up the insurance rates of millions of New York automobile owners.”
The scheme got its name from the plan’s alleged mastermind Daniel Levy, 32, of Rego Park, Queens. Levy owned and controlled two medical clinics: Bronx Sheridan Medical P.C. and New Lite Bronx Medical, P.C. Levy and his co-conspirators allegedly took advantage of New York’s Comprehensive Motor Vehicle Insurance Reparations Act, commonly referred to as the no-fault law.
The no-fault law reimburses persons who are in injured in minor accidents for medically necessary medical and health services, including initial medical evaluations, physical therapy, chiropractic care, acupuncture, and diagnostic testing.
According to the DOJ, Levy allegedly paid Desmond Connell, an attorney, to drive business into Levy’s clinics. Connell increased business by paying hospital employees to provide him with the information for patients who had recently been in minor vehicle accidents. Connell then allegedly gave that information to “steerers” whose job it was to contact the patients and convince them to receive unnecessary medical treatment at one of Levy’s facilities.
Patients allegedly received months of unnecessary treatments, including acupuncture, physical therapy, chiropractic treatment, psychological counseling and neurological testing. The healthcare providers involved in the Levy Enterprise billed the insurance carriers for this treatment and received millions of dollars.
The steerers allegedly told patients to make up false injuries in order to increase their chances of landing a big injury settlement. The DOJ also alleges that the steerers directed patients to Connell’s preferred attorneys to handle their cases. Connell preferred those attorneys because they allegedly paid him 40% of the settlement amount.
In addition to Levy and Connell, 10 others were included in the 147-count indictment.
Related Products
Most Popular
- Articles
-
- Joint Commission creates new Sentinel Event Alert for violence against healthcare workers
- Practice the six rights of medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Differentiate between types of wound debridement
- Don’t forget the three checks in medication administration
- OB services: Coding inside and outside of the package
- Complications from immobility by body system
- Avoid Eyewash-Related Regulatory Compliance Issues
- What does case-mix index mean to you?
- Know guidelines and subtle differences in code descriptions for laceration repairs
- E-mailed
-
- Joint Commission creates new Sentinel Event Alert for violence against healthcare workers
- Joint Commission now allows partially-used oxygen canisters in 'full' rack
- Dig into the details of wound care documentation
- Using the JCAHO's six competencies to evaluate MD performance
- HIPAA Q&A: Transporting records to satellite clinic
- Examine documentation for clinical indicators that provide context for MCCs
- Do not append modifier -52 to procedures involving equipment failure
- Differentiate between types of wound debridement
- Data gathering/reporting: One CDI specialist shares her hospital's methodology
- Countdown to new CMS emergency preparedness rules begins
- Searched