Busting Florida PIP Fraud
Acting Attorney General for the Southern District of Florida released a previously sealed 30-page indictment filed in U.S District Court recently and the allegations concerning PIP fraud are staggering.
Felix Filenger, Andrew Rubinstein, and Olga Spivak were charged with a total of seven-counts including conspiracy to commit racketeering activity; conspiracy to commit mail fraud, wire fraud, and health care fraud; conspiracy to launder monetary instruments; and four counts of making false statements relating to healthcare matters.
According to the indictment, Filenger and Rubinstein allegedly built and operated a criminal enterprise aimed at defrauding insurance companies out of millions of dollars by taking advantage of Florida’s No-Fault Personal Injury Protection (PIP) laws
What is PIP?
Under Florida law, insurance companies are required to provide PIP to the named insured on the insurance policy, the insureds relatives residing in the same household, persons operating the insureds motor vehicle, and pedestrians or cyclists struck by the insured’s vehicle who suffer bodily injury. [See Fla. Stat. §627.736 (1)]
The rationale behind the law is to provide victims quick access to medical care following an accident, regardless of who caused the collision. If injured Floridians get the medical care they need without hassle, then the courts aren’t flooded with minor cases and can instead focus on more serious cases.
Under the statute, reimbursement for services rendered by medical providers are limited to a maximum of $10,000 if a licensed medical professional determines that the accident victim suffered an Emergency Medical Condition (EMC). An EMC is defined as “severe pain that jeopardizes the patient’s health or impairs the patient’s bodily function”.
Florida Attorneys Filenger, Rubinstein, Olga Charged with PIP Fraud
The indictment, alleges that beginning sometime in 2010 and lasting until their arrest, Filenger, Rubinstein, Olga, and others conspired to and were successful in defrauding insurance companies out of approximately 23 million dollars “by obtaining the maximum amount of PIP funds through: (1) the establishment and operation of chiropractic clinics/rehab facilities; (2) the use of nominees; (3) the illegal solicitation of patients; (4) the fraudulent submission of documents reflecting facility ownership; (5) the billing for unnecessary and/or inflated treatment modalities, regardless of medical necessity; and (6) the misrepresentation of patient injury and pain levels; … to [then] launder the criminal proceeds derived from the Enterprise activity, … among other criminal activities”.
According to Prosecutors, Filenger and Rubinstein would allegedly recruit those who had access to confidential traffic crash reports, such as tow truck drivers and body shop workers, to refer accident victims to rehab clinics the two owned and operated throughout the South Florida area.
Fla. Stat. §316.066 makes confidential and exempt from disclosure automobile accident crash reports that reveal the identity, home, or employment telephone number or home or employment address, or other personal information concerning the parties involved in the crash for a period of 60 days after the crash report is filed. There are some exceptions.
In return, Filenger and Rubinstein would pay these “runners” kickbacks which, the indictment alleges, ranged anywhere from $500 – $2,500 per patient.
The indictment goes on to allege that “the co-conspirators agreed that, regardless of medical necessity, the patients should receive treatment at the medical clinics for a specific number of visits for unnecessary or inflated treatment modalities [so that] the co-conspirators could obtain the maximum payments under the patient’s auto insurance policy (PIP), and so that the co-conspirator corrupt attorney could attempt to obtain greater settlements from the insurance companies from the ensuing bodily injury lawsuits”.
Attorney Jason Dalley, 66, of Lake Worth was among those charged in connection with the fraudulent scheme. Others involved included Richard Yonover and chiropractor Linda Varisco who face a maximum of five years in prison and up to $250,000 in fines.
Filenger, Rubinstein, and Olga, who were all jailed on racketeering and fraud charges, could be facing more than sixty years in prison as well as upwards of a million dollars in fines if convicted.
GEICO Lawsuit Against 411 PAIN for PIP Fraud
The indictment shares a striking resemblance to the complaint filed by GEICO against 411 PAIN in the Florida Middle District Court on November 27, 2017. In that case, GEICO “seeks to recover more than $15,000,000 that defendants wrongfully obtained from GEICO by submitting, and causing to be submitted, thousands of fraudulent no-fault insurance charges”.
As in the criminal case, GEICO alleges that the owner of 411 PAIN, Robert Lewin, sought to utilize his 411 PAIN referral service to funnel accident victims into his large network of chiropractic offices. Once clients were being treated by Lewin’s medical clinics, GEICO alleges that Lewin and his co-conspirators committed “fraudulent protocols designed solely to financially enrich the Defendants, rather than to treat or otherwise benefit the insureds who purportedly were subjected to them”.
Within the same lawsuit, GEICO also alleges similar illegal activities as the ones stated above involving attorneys illegally obtaining personal injury clients. The 411 PAIN lawsuit also names the law firms Landau & Associates and The Law Offices of Kanner & Pintaluga; as well as the individual attorneys Todd Landau, Howard Kanner, and Eric Pintaluga as defendants. The complaint accuses them of participating, conspiring, aiding, and abetting their co-defendants. GEICO claims that injured parties would call 411 PAIN and then be either referred right to a Path Medical clinic or would be referred to Kanner & Pintaluga or Landau & Associates who would then refer their new client to get treated at a Path Medical clinic. This process is known as a self-referral and is illegal. The lawsuit goes on to claim that Path Medical provided clients to Landau & Associates and Kanner & Pintaluga so that they could pursue PIP billing complaints which generated massive attorney’s fees for the firm. In the end, the whole mess appears to be a system in which the clinics referred to the attorneys, and in return the attorneys referred to the clinic, all the while making both parties millions of dollars by defrauding the PIP system.
Although no criminal charges have been filed thus far in the GEICO vs. 411 PAIN case, the indictment of Filenger, Rubinstein, and others involved in that alleged conspiracy may make Robert Cash Lewin and other professionals involved in similar activities be weary of charges to come.
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