New Jersey – An automobile accident scheme has surfaced as a Newark judge has found 59-year-old Luis G. Aguirre guilty for his participation in the scheme. Aguirre is responsible for either fabricating or exaggerating the injuries of motor vehicle accidents in order to file claims made to the insurance plan known as the Personal Injury Protection (PIP) insurance plan. These claims would involve unnecessary services that were billed to insurance plans unnecessarily, a U.S. Attorney announced.
Aguirre, a resident of Hudson County, New Jersey, is charged with at least one count of conspiracy where the defendant is accused of committing health care fraud through exaggerated motor vehicle accidents.
The documents that were filed states that the automobile accident scheme had originated from Bergen County, New Jersey, where Aguirre would act as a “runner,” recruiting and identifying victims of recent car accidents that would be willing to take part in the scheme. Once the deal had been done, Aguirre would introduce the victims to medical imaging centers, chiropractors, and various other specialists. These medical professionals would then bill PIP insurance plans for services that were ultimately seen as medically unnecessary.
Along with an auto body shop employee located in West New York, New Jersey, Aguirre went about recruiting certain individuals who had been involved in motor vehicle accidents. These recruited members had been found either through connections with health care providers found in New Jersey or simply through word-of-mouth from around the community.
It is believed that the auto body shop employee involved was paid by Aguirre for every accident victim recruited to the scheme. The employee would then go on to pay the accident victims for their participation. Aguirre also made sure these accident victims filed police reports that would support the insurance claims.
Aguirre then directed the accident victims to visit specific health care providers to obtain medically unnecessary exams and services, such as X-rays and MRIs, for fake or exaggerated injuries that they supposedly suffered during the automobile accidents.
Health care providers are alleged to be paying Aguirre $500 for every accident victim he was able to rope in. These health care providers would then submit insurance claims that were sent to PIP insurance plans. This was done on behalf of said accident victims.
A case from September 25, 2018, highlights the activities done. The case is one that emerges from North Bergen, New Jersey, where an individual had been involved in a car accident. The accident occurred in Elizabeth, New Jersey, where the individual in question filed a police report describing the incident. The incident was only minor with another driver rear-ending the individual in question. Both drivers had stopped at a red light when the rear-ending occurred. The individual involved refused on-scene medical treatment preferring to seek separate medical treatment. The auto insurer the accident victim had at the time had PIP coverage included.
Aguirre had learned from his connection at the auto body shop that the accident victim had been willing to play a part in the scheme in return for a cash payment. Aguirre then directed the accident victim to visit a proprietor to the Rochelle Park MRI Centre in New Jersey on October 12, 2018. The accident victim was put through a series of X-rays that inevitably proved to be medically unnecessary. Four days later, the MRI Centre sent in the bill to the accident victim’s PIP insurance policy.
It is estimated that PIP insurance plans lost over $250,000 while the losses caused by the conspiracy exceed well over $3.5 Million. Luis Aguirre may face the maximum penalty of 10 years behind bars while having to pay a fine of about $250,000. Sentencing in the matter is scheduled to begin on July 14, 2020.
Automobile insurance fraud is a severe offense that tarnishes the record of every insurance company either involved or not. It is an offense that affects multiple industries, including the healthcare industry. Lives and jobs are affected by this crime every day, and you can help stop that behavior now.