Operators use stolen credentials to invent fake treatments for accident victims and send auto insurers the bill
Ontario’s car insurance industry is under attack by bogus medical clinics that use fake accident treatment charges to milk the system.
- $1,247 for a portable acupuncture machine.
- $2,363 for “aqua fitness therapy.”
- $450 for pain-relieving massages.
Then there was the $1,293 invoice submitted to an insurer for a long-handled Swiffer and other equipment to help a Toronto man with a minor injury clean his house.
None of these treatments or machines were provided to accident victims.
Doctors, chiropractors and physiotherapists are unwitting dupes in what some insurers claim is a $1.3-billion scam. Fraudsters steal their credentials to make fake invoices appear legitimate. The victims of the scam are drivers across the province, who annually see their rates hiked to pay for fraudulent claims.
Insurance investigators claim more than 300 clinics loosely connected in fraudulent rings are working this system.
“This is the bane of my existence for the last year,” Dr. Tajedin Getahun, a Mississauga physician, said in an interview.
His stolen signature was on treatment plan invoices for a series of costly devices he said he would never prescribe. One was a “whole body vibrating plate,” priced at $1,980, the other a $998 “biofeedback device.”
Travel around Toronto and you will see more and more of these rehabilitation clinics popping up. Anybody can open one and they are not regulated. One New York man with an auto insurance fraud conviction is listed as administrator of a Mississauga clinic.
Some people who visit bogus clinics are legitimate victims.
Others are part of the scam, either faking injuries or claiming for injuries that are the result of staged accidents.
Here’s how it typically works.
Tow truck drivers or paralegals direct accident victims — drivers and passengers — to rehab clinics. They might get a finder’s fee of $1,000 cash or, in the case of paralegals, a percentage of the payout. It is not uncommon for a clinic to bill an insurer $40,000 over the life of a claim.
The accident victims the Star found often spoke little or no English. At the clinic they were handed forms to sign that gave the clinic the right to submit claims to their insurance firm and receive payments.
Insurance companies only pay out if treatment is given by a regulated health professional — a doctor, chiropractor, physiotherapist, or massage therapist. It appears that clinics sometimes steal a professional’s information. In other cases, a professional briefly worked in the clinic and left behind a college-issued registration number and electronic signature.
“It’s sort of a murky world out there when it comes to these assessment clinics,” said Rocco Neglia, vice-president of Economical Insurance Group.
It’s tough to police a system where clinic owners and staff do not need any accreditation or credentials and get unrestricted access to confidential health information. Insurance investigators say clinics swamp insurance claim departments with hundreds of claims, often late on a Friday, figuring that while some will be rejected, many will be paid.
“They’re really treatment mills and for the longest time they’ve been operating with impunity. . . . This is why insurance rates can give you whiplash,” Neglia said.
Woodbridge realtor Steve Moustakas suffered minor back pain after his Cadillac was T-boned in June 2010. A tow-truck driver at the crash scene suggested a local paralegal firm could “help” push Moustakas’s claim through the “complicated” insurance system.
Moustakas visited paralegal firm Lofranco Scarola Wentzel, where a client relations manager provided a list of four clinics. Moustakas chose Osler Rehabilitation in northern Etobicoke.
Moustakas said Osler staff booked him for three to five treatments a week and he visited the clinic for two months, then quit. He recalls on each visit being pressured to sign many documents.
Months after he stopped visiting the clinic, his insurance company told him thousands of dollars of treatments were billed using his name as a patient and a series of doctors who, Moustakas said, he never saw.
“I didn’t know what I was getting into,” he said.
The invoices claimed he had not only attended Osler, but also another clinic called Assessment Direct where, the papers said, various doctors gave him numerous, costly treatment assessments.
One invoice from Assessment Direct totalled $995.69 for eight services such as “documentation support activity” and “counselling, promoting health and preventing disease,” which Moustakas never had and knows nothing about. Another for nine services, including “other” and “assessment mental health,” totalled $1,959.90.
In total, Economical Insurance estimates that $37,000 in assessment and treatment costs were submitted by clinics in Moustakas’s name. Economical became suspicious and only paid out about $2,500.
Moustakas said he never went to Assessment Direct and never saw any of the doctors (plus a psychologist and a dentist) named as providers on the claims.
Bombarded by bills from the clinics, Economical sent Moustakas to its own professionals to determine whether the invoices were legitimate.
In October they sent him to a dentist, who asked to see Moustakas’s X-rays.
“What X-rays?” Moustakas asked. “My teeth were never injured in the accident.”
To sort out the mess he was in, Moustakas went back to the paralegal firm for advice. Paralegal Joseph Corriero, whom he had previously dealt with, responded by sending Moustakas a batch of blank insurance expense forms, instructing him to sign — but not date — the documents and return them to him “as soon as possible.”
Moustakas became suspicious, alerted his insurance company and wrote Corriero a scathing letter, terminating their relationship.
When the Star contacted Corriero about this story, he sighed, “Oh God.” Corriero said his job is to “handle claims” and he declined to comment on the blank invoice allegation. He said there was “a breakdown in communication” between him and his client.
Corriero works on a contingency basis, claiming a percentage of everything an insurer pays. He has been sending Moustakas bills, asking him to “kindly remit” 20 per cent of the money he believes his client received from the insurance company for caregiver and housekeeping benefits. One of Corriero’s bills was for $1,270.12.
Officials at the two clinics would not answer questions from the Star.
Loreto Scarola, head paralegal at Lofranco Scarola Wentzel, says that sending blank expense forms for client signature is common practice at the firm.
“It saves the client from having to come in every two or three days” to sign papers. He said the firm gives the client copies of everything it sends to insurance companies so the “client is fully apprised of what’s been submitted on their behalf.”
Scarola said “there’s no basis for any accusation” lobbed at his firm. Moustakas is “barking up the wrong tree here. As far as we’re concerned this is all absolutely false.”
While there is no regulation or accreditation of clinics, the province has recently created a registration system called HCAI — Health Claims for Auto Insurance.
Registration is required to submit a claim, and 6,771 clinics or individuals are registered, three-quarters of them clinics and half of them in the GTA. There is no cost to register and no vetting of registrants.
The Insurance Bureau of Canada has created a tracking system that loosely links 300 GTA clinics.
The IBC has in the last two years passed on information on suspected cases of fraud to the Financial Services Commission of Ontario, leading to four convictions of clinics for providing false information to obtain payment from an insurance company.
The punishment is a fine; in one case the clinic was ordered to pay $50,000.
Meanwhile, insurance companies have started suing clinics and their owners.
In one case, a lawsuit by Economical Insurance alleges Toronto Regional Medical Assessment Centre director Danny Grossi and other defendants used the information of 55 car accident victims, the majority of whom do not speak English, to submit fake invoices to three insurance companies.
The alleged fraudsters then ripped off the electronic signatures of health care professionals and pasted them onto the invoices.
Grossi, an anesthetist in training, is under investigation by the College of Physicians and Surgeons. The college would not reveal the allegations it is investigating.
On invoices the insurance company says are fake, Grossi’s name appears as a “provider” of service.
In his statement of defence, Grossi denies “any role in the conspiracies alleged” and in a letter to the Star his lawyer, Joseph Falconeri, writes that Grossi has himself been exploited and “there are serious and significant concerns with respect to Dr. Grossi’s signature being misappropriated by third parties.”
Grossi directed the Star to his lawyer when a reporter tried to interview him at his Dufferin St. clinic.
Before publication of this article, Grossi sued the Star, seeking $10 million in damages, claiming that the Star reporter’s “aggressive manner” of researching caused doctors the reporter interviewed to resign from the clinic where Grossi is director.
Getahun is one doctor the Star interviewed as part of its research on the Toronto Regional Medical Assessment Centre. He said he discovered his signature was stolen last year when insurance investigators called to question him about out-of-character treatment recommendations that bore his name.
Getahun briefly worked for Grossi’s clinic and provided a statement to insurance investigators.
“It has been an absolute nightmare,” Getahun said. “I can’t understand how someone would have the audacity to do this.”
Health care professionals from all disciplines say the province must do something to stop their credentials from being misused.
In a case related to a different series of clinics, chiropractor Nasim Husnani discovered last year her signature was being pasted onto hundreds of fake invoices.
After she left a short stint at a clinic in 2009, her signature was used on invoices submitted to State Farm Insurance Co. by two other clinics where she had never worked. “I went to school for eight years and then someone comes along and decides to rub your name in the mud,” Husnani said.
One Toronto man, 78-year-old George Antoniadis, was confused about his entire experience at a mid town clinic after he suffered shoulder and knee pain following a rear-end collision.
A lawsuit alleges the clinic filed dozens of fake invoices worth more than $6,000 in Antoniadis’s name. When a Star reporter interviewed Antoniadis, he said the only treatment he received came in the form of a “Magic Vibro Belt” that is advertised on the web as a “slimming device” at $99.
Michele Henry – The Star – 2011-07-13.
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