Fraud In Insurance By Doctors

Tarrant County Insurance Lawyers will see situations where a health insurer turns down claims. Those same attorneys sue health insurance companies for mis-treating claimants. The Insurance Journal ran a story that shows the doctors doing wrong. The title of the story is, N.Y. Doctor Found Guilty In Massive No-Fault Insurance Fraud Claim.
Authorities announced that a Brooklyn, New York-based doctor has been found guilty in a no-fault insurance fraud scheme following a two-week jury trial.
According to a statement Monday from Preet Bharara, the U.S. Attorney for the Southern District of New York, Tatyana Gabinskaya was found guilty on Oct. 3 of various health care fraud and mail fraud offenses.
The jury convicted Gabinskaya of charges arising out of her involvement, from 2007 through 2012, in what has been described by authorities as the largest single no-fault automobile insurance fraud scheme ever charged.
Gabinskaya is the 32nd defendant convicted in this case following arrests in 2012, as part of an indictment that charged 36 defendants with conspiracy to commit mail fraud and health care fraud and charging some defendants with racketeering and money laundering.
Under New York state law, every vehicle registered in the state is required to have no-fault auto insurance, which allows the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an auto accident, regardless of fault.
Under the no-fault law, patients can assign their right to reimbursement from an insurer to others, including medical clinics that provide treatment for their injuries. New York state law also requires that all medical clinics in the state be incorporated, owned, operated, and/or controlled by a licensed medical practitioner in order to be eligible for reimbursement under the no-fault law. Insurers will not honor claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.
Authorities said that according to the superseding indictment and evidence admitted at trial, the true owners of these medical clinics paid licensed doctors to use their licenses to incorporate the professional corporations, through which the true owners billed private insurers millions of dollars for medical treatments and tests, many of which were not medically necessary.
Authorities said Gabinskaya was the stated owner of one such clinic that provided MRIs and other radiology tests, although the clinic was, in reality, owned by her co-defendants Mikhail Zemlyansky and Michael Danilovich. In addition, Gabinskaya was the stated owner of six other medical professional corporations, including five incorporated in the span of approximately one year.
When interviewed under oath about her role at the clinic controlled by Zemlyansky and Danilovich, Gabinskaya repeatedly lied under oath to deceive the insurers and induce them into paying claims that were not eligible for reimbursement, according to authorities.
Gabinskaya was convicted of one count of conspiracy to commit health care fraud and one substantive count of health care fraud, each of which carries a maximum sentence of 10 years in prison. She was also convicted of one count of conspiracy to commit mail fraud and one substantive count of mail fraud, each of which carries a maximum sentence of 20 years in prison. She is scheduled to be sentenced in January 2015.
Two of her co-defendants, Billy Geris and Joseph Vitoulis, were acquitted at trial. With respect to co-defendants Mikhail Zemlyansky and Michael Danilovich, the jury acquitted on some counts and hung on other counts. Zemlyansky and Danilovich are scheduled to be retried in January 2015. Co-defendant Matthew Conroy is scheduled to stand trial beginning December. A trial has not yet been scheduled for co-defendant John Maurello.
Thirty-one other defendants, including three other doctors, have pled guilty to, among other things, conspiracy to commit health care fraud. Charges were dismissed against three other defendants, one defendant entered into a deferred prosecution agreement, and one defendant died during the pendency of the case.