It's been a while since I posted, but yesterday something happened which fired me up, and not it a good way. One of my patients came in and told me about some lady he heard of, who had a car accident a few weeks ago. This person lives somewhere in Cutler Ridge, which is South West Dade County, FL.
So, she had an accident, and she is now treating at a chiro office with her boyfriend, who was the passenger. So, for a few minutes we were discussing the way the PIP works, and difference between first party insurance, and the at fault party's insurance, etc. And then, out of the blue, my patient asked me about the $2000 dollars that this woman got, and the $2000 her boyfriend got, UP FRONT for their "settlement", at the chiro office. The reason my patient was asking about this, is because, as an ex insurance utilization employee, he was wondering why these two people were also told to come in to the office five times a week, for what appeared to him to be a minor car accident.
Now, I am a pretty calm person 99% of the time. Very mellow. Maybe, even too mellow.
Considering the unbelievable nature of this story, I actually think I controlled myself fairly well. But, I think that by the end of the visit with my patient, he was a little rattled up, because he has never seen this side of me.
As a doctor who has been practicing chiropractic for over 20 years now, I feel I have a good grasp of the way these scams work. And, if you are reading this and you are not either a doctor or a lawyer, and you are maybe a little naive, I will explain to you what is actually happening at this office in Miami with these patients, and probably a lot of other patients who are coming in for treatment over there.
This is likely the sequence of events and facts that surround this crime:
The patients are in their car and are in an accident. Maybe the accident was staged, maybe not.
The injured patients called one of the lawyers who advertise on TV during the time when the Jerry Springer Show, or similar is on. Or, maybe they called 411-Pain or one of the other ones that are popular these days, The patients are referred to a doctor's office and are told that the office will take very good care of them.
The doctor's office looks at the "case" and realizes the at-fault party has a small or bad insurance company, or maybe that at-fault vehicle has no insurance at all. However, the patients have one of the larger carrier well known insurance companies like Allstate, Geico, State Farm, or Progressive. The office quickly sees that the patients have a very bad case because of the bad coverage on the other side, and the patient's policy has no uninsured motorist coverage, but the two patients do have $10,000 in coverage, EACH, in fact.
Since the doctor's office knows that if the patients find out they have a bad case, they wont come in for treatment, the office offers the patients up front cash, to come in, and come in frequently and a lot, so the office can quickly bill through the entire insurance benefit until its exhausted. The possibility is that that this inducement or kickback is also provided when the patient actually knows they have no case. Yes, lots of times these patient's come in expecting this cash kickback, because they heard that some offices do this. In other words, they shop around for it, until they find an office who will pay them, and an office that will pay the most.
Either way the kickback is provided because the doctor knows that the patient will have no "incentive to treat" because they really dont have pain, but they just want money.
So, the doctor's office pays out $4000 and then bills $20,000. This leaves the office with $16,000.
Yes, this scam happens. Not always, but it does happen. For those who are reading this and are thinking that all personal injury is a scam, you are wrong about that. Please dont group the legit medical and legal offices with total scam insurance fraud scheme offices. It is unfortunate, but there are bad players in every profession.
The truth is that there are patients who are injured and who are treated correctly, legally, professionally, and are helped. You just have to make sure you go to a good office, and if you are using an attorney to help compensate you for your injury, you go to a good, and legit attorney.
If you are a patient and are tempted to accept a kickback from the medical office or someone working outside the medical office, be aware, that not only is the office committing insurance fraud, but YOU are too. This means that you will be subject to prosecution and face the possibility of jail time, the same as the person who gave you the money. And if you think you will not get caught, think again. The insurance companies and the insurance fraud task force know the offices who are doing this, and they are waiting for the right time to rush into the office with guns drawn, and with the news crew present, to make an example out of you, and place your face and name on the front page of the news paper and the 5 o'clock news.
I have been treating patients who have been injured in car accidents for over 20 years. If you would like information, please call my office and I would be happy to discuss how I can help you, the right way.
Dr. Alan Himmel