Attorney General Cuomo Announces The Arrests Of Eight Suspects In No-fault Insurance Fraud Scheme
NEW YORK, NY (September 8, 2010) - Attorney General Andrew M. Cuomo today announced criminal charges against seven medical professionals and a clinic receptionist for their roles in a fraudulent scheme in which tens of thousands of dollars in phony claims were submitted to insurance carriers.
According to the complaint, the defendants operated a corrupt medical clinic at 115-13A Merrick Boulevard in Queens, New York (“The Merrick Boulevard Clinic”). Auto-accident victims were allegedly recruited to the Merrick Boulevard Clinic by runners, who were paid by the Clinic for each patient solicited. Patients were directed by the runners and by clinic staff to attend the clinic multiple times per week for several months and were directed to undergo unnecessary treatments including initial evaluations, physical therapy, chiropractic treatment, acupuncture, and diagnostic testing.
The complaint also alleges that providers at the Merrick Boulevard Clinic, including medical doctors Ernst Ducena and Emmanuel Gelin, chiropractors Aleksandr Mostovoy and Andrew Lopedote, and acupuncturists Shichao Xia, Sung Bok Lee, and Vladimir Grodskiy, submitted fraudulent bills to insurance companies under the no-fault law for services that were never provided to patients.
These arrests are part of a no-fault insurance fraud investigation by the Attorney General’s office, which included three undercover operations and court-ordered eavesdropping warrants.
“These individuals padded their pockets by billing insurance companies for unnecessary or nonexistent treatments, according to the complaint,” said Attorney General Cuomo. “Their scheme ran the gamut from doctors to the receptionist and it hurt the public, which is left to cover the costs through higher insurance rates.”
In New York State, a person injured in a motor vehicle accident is automatically covered by the Comprehensive Motor Vehicle Insurance Reparations Act, commonly referred to as the no-fault law. No-fault insurance carriers provide reimbursement for a wide range of medical and health services, including initial medical evaluations, physical therapy, chiropractic care, acupuncture and diagnostic testing, when such services are actually provided and are deemed medically necessary.
Today’s felony complaint charges the following defendants:
- Ernst Ducena, 53, Baldwin, NY, a medical doctor
- Emmanuel Gelin, 50, Baldwin, NY, a medical doctor
- Aleksandr Mostovoy, 35, Brooklyn, NY, a chiropractor
- Andrew Lopedote, 50, Hicksville, NY, a chiropractor
- Shichao Xia, 47, Oakland Gardens, NY, an acupuncturist
- Sung Bok Lee, 32, Queens Village, NY, an acupuncturist
- Vladimir Grodskiy, 45, Brooklyn, NY, an acupuncturist
- Fiammy “Gina” Cortorreal, 31, South Ozone Park, NY, a clinic receptionist
The 70-count felony complaint charges the defendants with: Scheme to Defraud in the First Degree, an E Felony; Insurance Fraud in the Third Degree, a D Felony; Insurance Fraud in the Fourth Degree, an E Felony; and Falsifying Business Records in the First Degree, an E Felony.
The charges against the defendants are merely accusations, and the defendants are presumed innocent until and unless proven guilty. The investigation remains ongoing.
The Attorney General’s office thanks the National Insurance Crime Bureau, Auto One Insurance Company, Liberty Mutual Insurance Company, Metlife Insurance Company, Lancer Insurance Company, and GEICO Insurance Company for their assistance in the investigation.
The case is being prosecuted by Assistant Attorney General Stephanie Swenton under the supervision of Deputy Bureau Chief Felice Sontupe and Bureau Chief Gail Heatherly of the Criminal Prosecutions Bureau. The case was investigated by Investigator Daniel Pisculli and Analyst Paul Strocko, under the supervision of Deputy Chief Eugene Black of the Investigations Bureau.