Posts Tagged ‘claims fraud’

Whiplash and incentives, abroad

“In my first 20 years as a consultant I wrote many reports which were economical with the truth – the truth being that there was very little wrong with the vast majority of compensation claimants that I saw. I was moving with the herd.” While lawyers, insurers, and others are all complicit, writes Dr. Charlie Marks, the onus is on the medical profession to speak up against medico-legal misdiagnosis [Irish Times via Patrick Collinson, The Guardian (“Whiplash: the myth that funds a £20bn gravy train”)]

Medical roundup

  • “Apple Watch can detect an early sign of heart disease…. Apple has been communicating privately with the FDA for years about medical devices and so far the FDA has taken a light touch to Apple but these issues are coming to a head.” [Tyler Cowen]
  • “[Investor] lawsuits targeting life sciences firms jumped 70 percent from 2014, according to a survey provided earlier this year by Dechert.” [Amanda Bronstad, New York Law Journal]
  • Iowa Gov. Terry Branstad signs medical malpractice reforms into law [Brianne Pfannenstiel, Des Moines Register]
  • Summing up what is known re: talc and ovarian cancer as background to jury’s $105 million verdict against Johnson & Johnson [BBC (in story’s second half), earlier here, here, and here]
  • $5,300 for an MRI that would cost Medicaid $500? Personal attendants for crash victims, even the ones well enough to participate in mixed martial arts? All part of Michigan no-fault crash system [Detroit Free Press investigative series, see yesterday’s post]
  • Dear D.C.: ditch the FDA deeming regs and let vaping save smokers’ lives [Jeff Stier/Henry Miller, NRO, Tony Abboud/The Hill (vaping trade association), Juliet Eilperin/Washington Post (FDA temporarily suspends enforcement)]

Detroit Free Press investigates crash-claim abuse

“Detroit drivers face the highest average auto insurance rates in the country, often more than $3,000 a year for a single vehicle,” while residents of Michigan as a whole pay the third highest rates of any state. A Detroit Free Press investigation by J.C. Reindl and others “finds that runaway medical bills, disability benefits payouts and lawsuits under Michigan’s one-of-a-kind, no-fault insurance system play a key role in driving up costs.” One key difference: of the twelve states that mandate no-fault insurance, only Michigan provides for unlimited lifetime benefits.

Some findings from the series:

* “Ambulance chasing” and solicitation thrive notwithstanding laws intended to curb those practices. Despite privacy rules governing police reports and hospital admissions, for example, those involved in crashes are often solicited within hours, then signed up with law firms that later disavow any knowledge of solicitation. And how did an accident treatment clinic in suburban Detroit come to be owned by a California and Florida plastic surgeon noted for appearing on “The Real Housewives of Orange County” who seldom visited?

* While crashes in Wayne County (Detroit) declined from 72,227 to 50,548 between 2003 and 2015, “first-party” lawsuits — against one’s own insurance company for no-fault benefits — increased from 1,699 to 6,327 and negligence suits against other drivers from 2,527 to 3,435. Many “first-party” claims, of course, are paid without anyone filing suit, which is how no-fault law contemplated would be normal practice;

* Auto insurers have launched racketeering lawsuits aimed at proving forms of collusive fraud. Unlike many states, Michigan has no official watchdog charged primarily with combating auto claims fraud.

* “Defenders of the current system include the powerful Coalition Protecting Auto No-Fault, made up of trial lawyers, medical clinics, disability advocates and, until recently, the state’s hospital lobby.”

* Other states’ approaches to containing no-fault costs.

Mikal Watts acquitted in Gulf spill claims fraud case

“San Antonio plaintiffs’ attorney Mikal Watts was acquitted Thursday by a Mississippi federal jury of multiple fraud counts after federal prosecutors charged that he submitted the names of phony clients seeking to recover from the 2010 BP Gulf of Mexico oil spill.” Two others associated with Watts’ firm were also cleared of charges. Watts, who represented himself at the trial, had argued that he was a victim of, rather than collaborator, in the wrongful practices of others who brought potential spill claimants in as clients for his firm. “The jury found several of the defendants Watts hired in Mississippi to gather clients guilty of the fraud allegations.” [Texas Lawyer]

Fraud week V: lucrative gore

A good bit of creativity has gone into the faking of accidents and injuries, from NYC injury king Morris Eisen’s special ruler for photographing the size of potholes (calibrated fictitiously so as to exaggerate their size) to the Philadelphia auto guys who “went as far as to have employees gather and store deer blood, hair and carcasses in the shop’s garage to be used as props in photos that were later submitted with insurance claims.” And some are more audacious than creative, as when a California woman got in trouble after allegedly sending “faked treatment documents and burn photos from a hospital website” to bolster a hot coffee spill claim against McDonald’s.

An entertaining and informative treatment of this subject is Ken Dornstein’s 1996 Accidentally on Purpose: The Making of a Personal Injury Underworld in America, about which I wrote this review at the time. Excerpt from my review:

In Illinois, runners took over the Community Hospital of Evanston, dispensing with doctors’ supervision and discouraging “real” nurses from applying. (“You’re going to be so bored here. There is nothing to do.”) The driver of the courtesy van whisking clients from law offices told why he liked the job: “No one is really hurt” so “no one gets sick on me”.

True-crime books usually aim to show how the dirty deed is done, and this one does not disappoint:

How do I get started? For a “paper” accident, try inflicting “controlled damage” on a couple of cars with a sledgehammer in a dark parking lot. Insert passengers. Summon a witness. Gather broken glass in bags for re-use.

That was easy, what next? “Staged” accidents: Buy rustbuckets, insure one and run it into another one full of recruited claimants-to-be (“cows”). If you’re nice, give them pillows.

I need symptoms! “OK, you can take tingles, and you can take hips or your shoulder,” said one coach to his aspiring victims. “But don’t go saying the exact same things.” And be glad you aren’t being sent to one of the House of Pain operations that massage would-be claimants with sandpaper and jagged can lids or flog them with apple-filled sacks. Let alone “Nub City”, the Florida town that, in the 1970s, could boast that something like 10% of its population had practiced self-amputation for insurance, typically popping a left hand with a hunting rifle.

Vernon, Florida, subject of a famous documentary by Errol Morris, is the subject of coverage here (“By the end of the ’50s, the Florida Panhandle was responsible for two-thirds of all loss-of-limb accident claims in the United States.”) and here.

Fraud week IV: lawyers who should know better

Where there is highly organized claims fraud, there are often found clusters of lawyers, doctors and their associates.

In Las Vegas’s Medical Mafia case, “physicians who played ball are said to have been assured protection from malpractice suits from many feared attorneys, while those not in on the scheme appear in some cases to have been at extra peril.”

Disloyal insurance company employees or counsel are sometimes in on the game too. California’s 1980s “Alliance” scandal, “a covert joint venture between plaintiffs’ and defense lawyers to manufacture and prolong legal claims for which the insurers would be obliged to employ legal counsel, bilked large insurance companies out of hundreds of millions of dollars in the 1980s.”

We could multiply examples many times over from mass tort fields like asbestos (with its creative witness-coaching and memory-massaging approaches to the issue of product identification) but for a good single episode, check out the banana pesticide litigation against Central American producers. Like many litigation campaigns, it generated a not-so-indie “documentary” (financed by plaintiff’s lawyers) billed around the film festival circuit as exposing multinational corporations’ guilt. That was before a federal judge described the litigation before her as a “pervasive conspiracy to defraud” its target, Dole.

Fraud week III: jump-ons

Jumping onto the hood of an oncoming car is one way of getting into claims fraud with minimal commitment, but there are many other ways, some of them quite complex and diabolical. After air crashes in Latin America in which U.S. residents lost their lives, it was noticed that a number of youthful claimants appeared on the scene whose mothers described them as the unacknowledged out-of-wedlock children of American men reported as lost on the ill-fated plane. These children, living in countries like Mexico and Guatemala, would then file claims in U.S. court against the airline, aircraft maker, and other potentially liable parties for cash settlements over the loss of what was said to be their father. These claims would come as bewildering, even horrifying news to the wives, children, and other family members of the deceased, who had to consider the possibility that the men they thought they knew so well had been living an undisclosed second life. At least one survivor — who probably had better reason that most to doubt the veracity of the claim — decided to fight:

In one case, a 53-year-old San Francisco man who perished on the doomed flight is alleged to have recently fathered two Latin American children who deserved to collect for his decease, a story that ran into trouble when his outraged gay partner of twenty years, Dale Rettinger, 63, stepped forward to challenge it.

For a defense by a Florida lawyer who had been involved in the filing of multiple surprise-heir claims, follow the above link. And more conventional jump-on fraud occurs when, say, a city bus with 15 passengers on board gets in an accident and by the time the police arrive the number of passengers is up to 30. (From 2014: Jackson, Miss. driver leaves scene of accident and returns accompanied by more victims.) And it even happens with cruise ships.

Fraud week II: caught on camera

Yesterday we posted about the North Carolina man who prosecutors say had the poor judgment to post YouTube videos of his staged crashes. It is continually surprising that people keep right on posting YouTube videos of themselves doing things inconsistent with their disability or injury claims. Don’t they expect anyone to watch? As for persons intending to commit claims fraud in stores, many appear entirely unaware that there are security cameras there to catch them doing things like “carefully positioning the spills on which they intended to slip.”

Dashcam videos are a genre to themselves, and popular compilations abound (Russia is a leader in the field) of footage of spectacular accidents, poor driving and road hazards as seen from the front of a speeding car. One reason dashcams are popular in many countries (often more so than here) is that they serve to document accident fault, including deliberately caused or simulated accidents. This American video (by a company promoting sale of its dashcams) gives a flavor.