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The Fraud Report

Insurance Scam Artist Throws Himself on Car

by FraudReport 17. October 2014 11:43
Just when you think you've seen every attempt at insurance fraud, someone new comes along and makes you rethink your sanity. And talk about someone desperate for money... this person obviously wanted the damage of getting hit by a car, without actually getting hit by a car.


Categories: Scandalous Schemes

NY Doctor Found Guilty in Massive No-Fault Fraud Scheme

by FraudReport 15. October 2014 07:00

On October 6th, the United States Attorney for the Southern District of New York, Preet Bharara, announced that Tatyana Gabinskaya was found guilty of various health care and mail fraud offenses. The jury in the two-week trial convicted Gabinskaya of charges arising out of her involvement in the largest single no-fault automobile insurance fraud scheme ever charged.

Gabinskaya, 60, is the 32nd defendant convicted in this case, stemming from arrests on February 29, 2012 as part of an indictment. The “Superseding Indictment” charged 36 defendants with conspiracy to commit mail fraud and health care fraud and charged others with racketeering and money laundering.

Under New York State Law, every vehicle registered in the State is required to have no-fault automobile insurance, which enables 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 automobile accident, regardless of fault, (the “No-Fault Law”). The No-Fault Law requires prompt payment for medical treatment, thereby obviating the need for claimants to file personal injury lawsuits in order to be reimbursed. Under the No-Fault Law, patients can assign their right to reimbursement from an insurance company 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. Insurance companies will not honor claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.

According to the Department of Justice press release, the Superseding Indictment and evidence admitted at trial: the true owners of those clinics paid licensed doctors to use their licenses to incorporate the businesses, which they then used to bill private insurers for millions of dollars. Gabinskaya was listed as the owner of a clinic that provided MRIs and other radiology tests, although it was actually owned by her co-defendants, Mikhail Zemlyansky and Michael Danilovich. Along with that clinic, Gabinskaya was also listed as the owner of six other medical facilities, including five that were incorporated in the span of about a year.

When she was interviewed under oath about her role at the clinic controlled by Zemlyansky and Danilovich, Gabinskaya repeatedly lied to insurers to get them to pay claims that were not eligible for reimbursement.

Gabinskaya was convicted on October 3rd of one count of conspiracy to commit health care fraud and one substantive count of health care fraud, plus one count of conspiracy to commit mail fraud and one substantive count of mail fraud. Each of the former charges carries a maximum sentence of 10 years in prison, while the latter two have a maximum 20 year sentence. Gabinskaya is scheduled to be sentenced on January 28th before U.S. District Judge J. Paul Oetken.

Gabinskaya’s first trial in the fall of 2013 ended in a mistrial after the jury failed to reach a unanimous verdict. Two of her co-defendants, Billy Geris and Joseph Vitoulis, were acquitted at their trials. The jury for Zemlyansky and Danilovich acquitted on some counts and hung on others; they are scheduled to be retried in January. Another co-defendant, Matthew Conroy, is set to stand trial on December 2nd. Co-defendant John Maurello does not have a scheduled trial date yet.

All in all, 31 other defendants –including three other doctors– have pled guilty to several things, including conspiracy to commit health care fraud. Charges were dismissed against three others, one defendant entered into a deferred prosecution agreement, and one defendant passed away while the case was still ongoing.

U.S. Attorney Bharara thanked the FBI and the New York City Police Department for their work, and the National Insurance Crime Bureau for its assistance; the case is being prosecuted by the Office’s Violent and Organized Crime Unit. The prosecution is being run by Assistant U.S. Attorneys Amanda Kramer, Janis Echenberg, Daniel S. Goldman, Edward Y. Kim, Peter M. Skinner, and Daniel S. Noble. Assistant U.S. Attorney Carolina Fornos is in charge of the forfeiture aspects of the case.

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Categories: Scandalous Schemes