A Hudson County, New Jersey, man, Luis G.🌌 Aguirre, 57, was sentenced on Oct. 5 to 12 months and one dayꦯ in prison for his role in an automobile accident scheme, U.S. Attorney Craig Carpenito announced.
It’s not clear which Hudson County municipality Aguirre is from.
As part of the sch🤡eme, health care practitioners fabricated and exaggerated accident victims’ injuries to support fraudulent insurance claimꦬs to Personal Injury Protection (PIP) insurance plans for medically unnecessary services.
U.S. District Judge Stanley R.🅠 Chesler also sentenced Aguirre to three yearꦅs of supervised release and ordered him to pay restitution of $53,710.
In March, Aguirre pleaded guilty in Newark federal court to an information chargi🌄ng him with one count of conspiracy to commit health care fraud.
Chesler imposed the senten🐠ce on Oct. 1 by videoc✱onference. Sentencing was scheduled for July 14 but was postponed due to COVID-19.
According to the U.S. Attorney’s Office, Aguirre’s participation in the conspiracy caused an estimated loss to PIP insura♚nce plans of more than $250,000. The total loss caused by the c♊onspiracy exceeded $3.5 million.
Recruiting victims
Aguirre helped to orchestrate an automobile accident scheme in Bergen County♚ and Hudson County by acting as a “runner” who identified and recruited accident victims to the scheme.
Aguirre subsequently introduced the vic🌜tims to various chiropractors, medical imaging centers, and others, who billed PIP insurance plans for medically unnecessary services.
Aguirre and an employee from an auto body shop in Weꦉst New York, Individual-1, identif𓃲ied and recruited individuals who had been in car accidents.
According to the U.S. Attorney, they found car accident victims through word of mouth in the community and෴ through relationships with health care providers in northern New Jersey.
Aguirre paid Individual-1 for each accident victim whom 🎐Individual-1 helped identify and recruit t🍨o the scheme. Individual-1, in turn, paid accident victims for participating in the scheme.
As part of the scheme, Aguirre ensured that the victims had filed police⛄ reports to support subsequent insurance claims.
Aguirre directed the accidꦚent victims to visit specific health care providers to obtain medically unnecessary medical examsꦡ and services, such as X-rays and MRIs, for fake or exaggerated injuries that they supposedly suffered during the automobile accidents.
Quid-pro-quo
Aguirre was paid approximately $500 in cash by the health care providers for each accident victim he delivered. Health care providers submi🅺tted insurance claims to PIP insurance plans on behalf of the accident victims.
On Sept. 25, 2018, an individual from North Bergen, known as🉐 Individual-3, was involved ꦰin a vehicle accident in Elizabeth.
U.S. Attorney Carpenito stated tha💦t based on a police report of the incident, the accident was minor. Individual-3 was rear-ended by another car when both were stopped at a red light.
According to the police𒆙 report, Individual-3 refused medical treatment at the scene, stating that Individual-3 would seek separate medical attention. At the time of the accident, Individual-3 had an automobile insurance policy through Auto Insurer-1, which included PIP coverage.
Aguirre learned from Individual-1, the WNY auto body shop employee, that Individual-3 was willing to participate in the sc🍰heme in exchange for cash payment. According to the U.S. Attorney’s Office, Aguirre directed Individual-3 On Oct. 12, 2018, to visit the proprietor of an MRI Center in Rochelle Park, known as Individual-2.
Individual🤡-3 agreed to the plan and visited the MRI Center, where Individual-3 underwent a series of medically unnecessary X-rays. On Oct. 16, 2018, the MRI Center billed Individual-3’s PIP insurance policy.
Carpenito credited special agents of the Department of Labor – Office of Inspector General (DOL-OIG) under the direction of Special Agent in Charge Michael C. Mikulka, and special agents of the FBI under the direction of Special Agent in Charge Gregory W. Ehrie in Newark with the investigation leading to the sentencing.
The government was represented by Assistant U.S. Attorney Jason 𓃲S. Gould of the Health Care Fraud Unit at the U.S. Attorney’s Office in Newark.
For updates on this and other stories, check www.iccwins98.com and follow us on Twitter @hudson_reporter. Daniel Israel can be reached at [email protected].
