Four Psychotherapists Charged In No-fault Fraud Ring
Attorney General Spitzer, State Insurance Superintendent Gregory Serio, and NYPD Commissioner Raymond Kelly today announced the filing of charges against four psychotherapists who fraudulently billed insurance companies for counseling services they claimed were provided to hundreds of motor vehicle accident victims. The defendants over-billed insurance carriers for services provided to patients or submitted bills for services that were never rendered.
The 263-count indictment, filed last week in Kings County Supreme Court, charges the defendants with conspiracy and multiple counts of grand larceny, insurance fraud, and falsifying business records.
"Insurance fraud is a crime against all New Yorkers. We pay the price for the defendants' greed through the resulting increased premiums," said Attorney General Spitzer. "By abusing the no-fault insurance system these professionals do a disservice to the very people they are supposed to help. These fraudulent practices have no place in New York and will not be tolerated."
"These practitioners tried to take the 'easy' way out and steal money from the insurance system. The announcement of these arrests proves that the Attorney General, the Police Commissioner and I want to make it clear - we will not allow there to be an 'easy' way to take money from honest insurance consumers who may pay more in premiums because of these fraudsters," said New York State Superintendent of Insurance Serio. "If you choose to commit insurance fraud in New York State you will be arrested and prosecuted to the fullest extent of the law."
"The psychotherapists charged in this fraud attempted to make illegal profits at the expense of several insurance companies. This is a familiar crime, motivated by greed, which hurts the average New Yorker in the form of higher insurance rates. I want to commend the Attorney General and the State Insurance Superintendent for their cooperation in this investigation," said Police Commissioner Kelly.
The defendants are Gabriel Feldmar, Ph.D., a licensed psychologist, and three psychotherapists under his employ, Brian McCarthy, Tomeka Austin, and Nasim Jadoon. Dr. Feldmar supervised Austin, Jadoon and McCarthy, in addition to other psychotherapists, at medical clinics throughout New York City and Long Island. At these facilities, patients were directed by clinic staff to meet with a psychotherapist supervised by Dr. Feldmar without regard to medical necessity. Many of the patients had suffered minor injuries as a result of car accidents in which the vehicles sustained little or no damage.
According to the indictment, during the period from April, 2000 to September, 2003, the defendants engaged in a conspiracy to submit falsified no-fault claims to insurance carriers for counseling services for hundreds of motor vehicle accident victims that were never rendered. They submitted fraudulent claims totaling approximately $88,000.
They engaged in several types of fraud. First, they billed insurance companies for patient counseling sessions which never took place. In a second type of fraud, the defendants submitted claims to no-fault carriers claiming patients received counseling with biofeedback training when in fact they had not. Biofeedback is a procedure in which the patient is trained to reduce stress and pain by using breathing and relaxation techniques.
A third type of fraud involved a practice known as "upcoding," in which the defendants claimed that a particular procedure lasted longer than it actually took to perform, resulting in a higher payment from the insurance carrier. The defendants provided patients with face to face therapy lasting less than fifteen minutes and in many cases less than one or two minutes. The defendants often approached the patients, briefly greeted them, and then asked the patients to sign an attendance sheet. The defendants then sent bills to the insurance carriers claiming that each patient had been provided with 45 to 50 minutes of face-to-face counseling.
Finally, the defendants over-billed insurance carriers for psychological testing and evaluation of patients. As charged in the indictment, Dr. Feldmar claimed that such services took 5 hours to complete for each patient. In actuality, the work was performed in no more than one to two hours and testing was performed on all patients regardless of whether such tests were medically warranted.
Under New York's no-fault law, a person injured in a motor vehicle accident can receive up to $50,000 coverage for medical expenses incurred as a result of the accident. Most health service providers are reimbursed directly by no-fault carriers for services provided.
Defendants Gabriel Feldmar, Brian McCarthy, and Nasim Jadoon were arraigned before Kings County Supreme Court Justice Daniel Chun and released on bail. Gabriel Feldmar, 56, is a resident of Bayside, New York. Brian McCarthy, 47, is a resident of Massapequa, New York. Nasim Jadoon, 49, is a resident of Eatontown, New Jersey. Tomeka Austin was arraigned yesterday before Kings County Supreme Court Justice Daniel Chun and released on bail.
The 263 counts of the indictment charge: Conspiracy in the Fourth Degree, Grand Larceny in the Third Degree, Attempted Grand Larceny in the Second Degree, Attempted Grand Larceny in the Third Degree, Attempted Grand Larceny in the Fourth Degree, Petit Larceny, Attempted Petit Larceny, Insurance Fraud in the Third Degree, Insurance Fraud in the Fourth Degree, Insurance Fraud in the Fifth Degree, and Falsifying Business Records in the First Degree.
Each of the defendants faces up to seven years in prison if convicted of the top count of the indictment. The charges are merely accusations and the defendants are presumed innocent until and unless proven guilty in a court of law.
Attorney General Spitzer thanked the National Insurance Crime Bureau, GEICO, American International Group, The Hartford Insurance Company, and Metropolitan Life Insurance Company for assisting in the investigation.
The case is being prosecuted by Assistant Attorney General William Jorgenson of the Auto Insurance Fraud Unit, under the supervision of Unit Chief Steve Nachman. Investigators Ronald Stripp, David Henry and Daniel Pisculli, with Supervising Investigator Dominick Zarrella and Deputy Chief James Conway, conducted the investigation, along with Detective David Moser and Detective Gerard Shanley of NYPD's Fraud Accident Investigation Squad.