Florida Investigation Focuses on Health Insurance Fraud
When one gets in a car accident, it is not unusual to require treatment for injuries sustained in the crash. For example, an accident involving intense whiplash could create back problems, which might call for treatment. However, what if an accident was staged and "harmed" individuals fraudulently pursued treatment? Moreover, what if the "treatment" was never provided and insurance money actually seeped into personal pockets? According to Florida investigators, some residents created fake car collisions in an effort to deceive the insurance system. The organized scheme involved clinic owners, medical specialists and recruiters.
Florida authorities brought charges against 33 individuals who were purportedly involved in faking accidents for insurance fraud. According to the Huffington Post, an investigation tracked and followed approximately $20 million in fraudulently received payouts from insurers for three years.
The federal and state investigation, "Operation Sledgehammer," precipitated charges against over 90 defendants in several Florida counties for insurance fraud. Convicted suspects have paid over $5 million in restitution to insurance groups, the Huffington Post reports. The term "sledgehammer" is used as an epithet for the operation because suspects have reportedly made vehicles look as though they had been in a collision through the use of a sledgehammer.
Investigators note that the operation ran from approximately October 2006 to December 2012. The suspects allegedly created accidents and submitted claims through 21 chiropractic centers in Florida, which the defendants controlled. Authorities claim that the scheme involved an intricate network of medical personnel and clinic owners who provided false diagnoses and prescribed unnecessary treatment. The leaders of the scheme recruited accident "victims" and trained them to stage crashes of Florida roads.
According to investigators, recruiters taught participants how to make car crashes look real, file police reports and submit insurance claims for injuries. Moreover, participants were specifically directed where to go for treatment. Insurance checks were deposited into accounts controlled by the leading defendants so they could pay participants.
Suspects have been charged with laundering money, mail fraud, structuring transactions and participating in accident fraud, according to the Huffington Post.
Health insurance fraud
When investigators suspect insurance fraud, they generally review clinic records to determine if the clinic could have provided the services it said it provided. In an investigation, authorities might interview patients to determine if they actually required or received the services, which the clinic claimed to have provided. Investigators often look for any indication of a false claim.
Insurance fraud is very serious. At the same time, some irregularities may exist in a system, which are not necessarily an indication of fraudulent behavior. Billing codes, records, timelines and other pieces of the process can be intricate and difficult to decipher.
If you are under investigation or have been accused of health fraud, you may benefit from working with an experienced criminal defense attorney.