An update on the 2005 indictment of 15 people (some health care providers)charged with 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 automobile accident cases.
Way back in March, 2005, Manhattan District Attorney Robert M. Morgenthau indicted fifteen people, including four doctors, a dentist, a psychologist, and an acupuncturist, on charges 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. Also indicted were a medical billing company, two health care clinics that were also professional medical corporations and three other professional medical corporations.
The defendants were charged with insurance fraud, grand larceny, attempted grand larceny and scheme to defraud. An examination of financial records revealed that the clinics billed more than sixty insurance carriers for millions of 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 ownership of a medical billing company and their control of medical clinics and professional corporations to defraud insurance carriers who paid out claims believing that the clinics were providing legitimate services. They also cheated patients by providing them with inadequate or medically unnecessary procedures.
The D.A.'s investigation revealed that the two Pustilniks, neither of whom is a doctor, operated Premier Medical Care and Omni Medical Care. They also Owned Empire Medical Management, a medical billing company. In addition, they were the covert owners of five medical corporations: both medical clinics, Premier Medical and Omni Medical, as well as University Psychological, Focus Acupuncture and Optimal Healthcare Medical.
It was also revealed through the investigation that the two Pustilniks used licensed professionals as 'fronts" or "Docs-in-the-Box" for the professional corporations to hide their ownership of the clinics. New York State law specifically prohibits the "corporate practice of medicine" and does not allow a medical practice or clinic to be directly owned by anyone other than medical doctors.
Generally the defendants submitted three types of fraudulent claims:
Billings for services in which the defendants claimed that they had seen and treated patients on dates when they had not.
Billings in which the defendants "up coded" - i.e., claimed that a particular procedure or doctor's visit lasted longer than it actually did to obtain a higher reimbursement rate.
Billings in which the defendants ordered testing that was not medicall necessary and testing that was never performed; two doctors ordered numerous unnecessary MRIs for the and one doctor ordered a brain MRI for a patient who only complained of lower back pain. The Pustilinks were believed to have spent the proceeds of their crimes on a Central Park West co-op, luxury cars and a $2 million property in upstate New York's Catskill mountain area.
So now let's update our report.
This past November, 2007, two of the medical doctors swept up in this bust were convicted in Manhattan on fraud, grand larceny and assorted other charges . Yesterday (February 11, 2008) the two medical doctors swept up in by the Manhattan District Attorney were sentenced to prison. Dr. Neurologist Victor Basbus was sentenced Monday to two - six years in jail, while Dr. Gerardo Yanayaco, an internist, will serve up to 10 months in jail.
Commentary: If you have an accident case and treated at one of these "dirty" clinics, your case will usually be worthless. Your medical records will be with the prosecutors, buried somewhere. And you can't hardly have a doctor testify in court after a felony conviction and still be a credible expert witness on your behalf. Also, the insurance companies know where these places are, so good luck getting them to pay you a fair settlement. So play it clean and steer clear of these places, some of which may offer you money to be a patient. If you visit my website, you can see my free special report on dirty doctors. Also, I touch on this subject in my free book: Good Lawyers Don't Call You First, also available on my website.
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