Another Insurance Scam Story....I'm so tired of this.

I'm Fired Up

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 also to 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, 1-800-NEED-HELP or one of the other ones that are popular these days. The patients THEN 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"after also communicating with the lawyer's office 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.   From this very quick investigation, the office quickly learns 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 won't 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 the insurance benefit is exhausted.

There is also a possibility that this inducement or kickback is also provided when the patient actually KNOWS they have no case.  YES, lots of times patients know about their lousy case, and these patients come in expecting this cash kickback, for simply becoming a patient, 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 don't 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 don't 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 who 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, and RUIN YOUR LIFE.

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.

Professionally yours,
Dr. Alan Himmel

See this Fantastic Whiplash Video Infographic. This is Why you have so Much Pain!

Dr. Himmel

I have been treating patients who have sustained whiplash for practically the last 2 decades. 

 Many people are unaware that even a small impact rear end collision can cause significant pain and impairment in certain cases.  Symptoms include pain, stiffness, headache, shoulder pain, arm pain, numbness, tingling, and weakness in the upper extremities.

If you have been injured in a rear end collision, do not hesitate.  You must get examined and if treatment is necessary, you should begin as soon as possible to try and prevent future, permanent, chronic problems.  

Call our office Today:  954-659-8600

Compliments of Accident Injury Centers of Atlanta,

Can Whiplash Cause Concussion?

Can Whiplash Cause Concussion?

Dr. Alan Himmel

Talked about it before.  Let's talk about it again.  Can a mild whiplash cause a concussion?  The literature says, yes.  And, I have had several patients over the years, and one currently, who has the affects of post concussion syndrome.

Attorneys who represent injury clients need to be aware of this issue as well.  The most recent patient that I am treating who I am sure has suffered a concussion, has all of the symptoms of this injury, including headache, vertigo, disorientation, and confusion.  This will be a patient who will tell you that their head just doesn't feel the same since the accident.  It can be very frustrating to the patient, and the patient may find themselves searching doctors who could figure it out.  Oddly enough, attorneys will very often dismiss concussion, wanting to focus the claim on disc injuries and the usual soft tissue findings. Why?

I think that the major sticking point for attorneys is simply not understanding the physics involved in a car accident, and not knowing what a concussion actually is.

You don't have to strike your head against the inside of the car and you don't have to get hit in the head by something to cause concussion.  Think of it like this:  The brain is encased within the skull and around the brain is a thin layer of fluid which separates the brain from the inside of the skull so it does not touch (among other purposes of the fluid). The fluid is called cerebral spinal fluid or CSF.  So, the brain, in a way, is swimming in this fluid and the small fluid space between the brain and the inside surface of the skull is like a barrier because you don't want the brain to touch anything.

Okay, now think about what will happen to a person's head when at rest, when the car he is in is hit from behind.  The person's head will move in the direction of where the force came from.  This is one of Newton's laws of motion.  Every action has an equal and opposite reaction.  But, what about the brain which is "floating" within the skull?  It too, must obey the laws of physics, and at this point, the brain will then crash into the inside of the skull on the opposite side.  Right there is your concussion.



Now, keep in mind that concussion is not always possible to see on MRI or CAT scan.  Concussion is regularly diagnosed based on neurological symptoms, signs, and complaints.  Lawyers and insurance companies want objective proof, but they cannot always have it with concussion.  The lawyer who is representing the client with concussion, must be aware of these things.  A lawyer who is representing injury clients must be an expert in the law, and although its not required to be trained like a physician, he should also have a working knowledge of different types of injuries involved.

So, keep an eye out for a concussion when whiplash is involved.  They are generally not life threatening, but concussions can be quite serious, and recurrent concussions can be even worse.

I can be reached at 954-659-8600

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL. 33027

Emergency Chiropractic Florida

Emergency Chiropractic Florida

Dr. Alan Himmel

I decided to create another website:   www.emergency-chiropractor-florida.com

I named it Emergency Chiropractic of Florida because I continue to see patients who have been to the hospital or other doctor after a car accident, and it has been determined that they have an "emergency medical condition."  The designation of emergency medical condition or (EMC) allows the patient to seek follow up care and be covered by his PIP insurance up to his full coverage limits. Without the EMC, he is limited to only 25% of the coverage he pays for.  Not all of my car accident patients actually do have a bonafide EMC, and as a matter of fact, the EMC is only present if certain medical providers such as an MD or DO say it is present.

Nevertheless, these emergency patients often end up calling me because of my experience and my knowledge in regard to the proper treatment, management, and documentation of these types of injuries.  This comes with practically 18 years experience.  If you have been injured in a car accident, please call my office.  The number is 954-659-8600.

Dr. Alan Himmel