Wednesday, 20 February 2013 18:52

Florida Chiropractor Gets 54 Months for Insurance Fraud

On Feb. 13, a southern Florida court sentenced Jennifer Adams, 39, to a mandatory 54 months in prison, to be followed by 3 years of supervised release. In addition, the court ordered Adams to pay $1,920,424.83 in restitution, sending a strong message to insurance scammers.

Adams previously pleaded guilty to a one-count information charging her with conspiring with others to commit mail fraud for her role in a staged accident fraud scheme.

According to court documents, perpetrators of the fraud scheme recruited friends and family members to participate in staged accidents. Under Florida’s no-fault law, insurers are required to provide personal injury protection (PIP) coverage of $10,000 per person. The recruiters referred to the individuals whom they recruited as the “Perro” and the “Perra.” The “Perro” was the person who “caused” the staged accident. The “Perra” was the person who was the “victim” of the staged accident and whose car was struck by the “Perro’s” car. Thus, if the recruiter found a Perro with a wife and two children and a Perra with two friends, for a total of seven participants, the maximum PIP benefit was $70,000.

Once the recruiters located willing participants, they provided coaching on staging the actual accident, what to relay to responding police officers, and how to report injuries. Following each accident, the Perro and Perra filed false claims with their insurance companies, alleging that they and their family members were injured.

Court documents also allege that accident participants were then directed by the recruiters to chiropractic clinics that were controlled by co-defendants. The staged accident participants completed paperwork falsely asserting that they suffered injuries during the staged accident. The co-conspirators advised the participants on how to fill out the paperwork and what to say if an insurance investigator interviewed them about their injuries or treatment. The staged accident participants were instructed to sign numerous blank treatment forms that would later be submitted indicating that they had visited the clinic on a number of separate occasions for treatment, although they may have visited the clinic only once or twice. During their visits, some staged accident participants received no treatment at all or may have received only a short exam or treatment from the chiropractor or LMT but the paperwork completed by the LMTs and chiropractors, including Dr. Adams, indicated that a full and lengthy exam and treatment was given.

Adams agreed to place her name on the corporate paperwork for two clinics, thereby using her status as a licensed chiropractic physician, to allow the clinics to bill insurance companies directly for PIP claims without obtaining additional licensure from the state of Florida. Those clinics were Ovy Rehabilitation Medical Center Inc. in West Palm Beach, Florida, and Chiropractic Office of South Florida in Palm Springs, Florida. Although Adams was named as the owner of the clinic on the corporate paperwork, the co-conspirators maintained control of the bank account and running the operations of the clinics.

Although Adams initially believed the clinics were operating legitimately, sometime thereafter she became aware that her license and status as a chiropractor was being used to fraudulently submit claims by U.S. mail to insurance companies.

Adams realized these patients did not require medical treatment and yet, according to court documents, continued to work at both clinics signing prescriptions for plans of treatment that she knew were not only medically unnecessary but also would be submitted for reimbursement to numerous insurers.

Authorities believe that from the time that Adams was informed about the fraud until the clinics were closed by law enforcement, the clinics submitted fraudulent claims that resulted in more than ten  insurance companies making total payments of $1,920,424.83.

Adams also received a salary for her work as a chiropractic physician paid from the COSF and OVY checking accounts. The bulk of the proceeds of the fraud were taken by co-conspirators.

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