Pursuing Auto Insurance Fraud as Organized Crime Pays Off

Investigators across the country are trying new tactics to crack down on the old problem of auto insurance fraud, using wiretaps, undercover agents and prosecutors who view the schemes and scams the same way they do organized crime.

In 2001, New York Gov. George Pataki appointed Attorney General Eliot Spitzer as special counsel to investigate the fraud that has helped drive up New Yorkers’ auto insurance premiums to second highest in the nation, cheaper than only New Jersey.

Deputy Attorney General Peter Pope, who oversees 100 lawyers and 100 investigators statewide as the head of the office’s criminal division, said that simply going after street level perpetrators isn’t enough.

Instead, he’s taken an organized crime approach, using wiretaps and undercover agents to nab shady doctors, lawyers and the “silent owners” of establishments that bilk the insurance industry out of $25 billion to $30 billion a year.

Frank Scafidi of the National Insurance Crime Bureau said the fraud translates into higher rates for everyone, though he and others say there are no reliable estimates of how much it adds to the average consumer’s bill nationwide.

The yearly cost is “enough that it’s really hurting everyone’s wallet,” said Howard Goldblatt of the Coalition Against Insurance Fraud.

In New York City in March 2004, 11 people and seven companies were charged in connection with a scheme that prosecutors said defrauded insurance carriers out of $1 million. Doctors, lawyers and others were accused of soliciting accident victims to be treated at IK Medical, a clinic run by Dr. Irina Kimyagarova. The indictment alleged that the clinic was controlled by Emil Izrailov and Robert Shimunov, two silent owners who had no medical training.

Once patients came to the clinic, they received a wide range of unnecessary treatments, including physical therapy, acupuncture, psychotherapy and dental care, according to the indictment. The case is scheduled for trial in September.

“You don’t really make an impact until you make a jump into clinics and the silent owners,” Pope said. “Then you also get to the crooked lawyers. We’ve been able to get a number of them as well.”

Pope said the use of wiretaps and undercover officers has given investigators better leverage to make their cases.

“If I’m trying to prove the patient in fact didn’t have the symptoms he was being treated for, the only way to do that is to find real patients or send undercovers into the clinic,” he said. “The biggest investigations and those with the widest reach occurred when we were listening in with court approval.”

In California, police are trying to educate the public about potential fraud schemes.

In one common scam, called the “swoop and squat,” a motorist is driving along at a safe distance from the vehicle in front of him. Another car will then begin to tailgate the unsuspecting driver while another vehicle will pull up alongside, honking and swerving to draw attention. Just as the unwitting driver is distracted, the car in front slams on the brakes, causing a rear-end collision.

The hit car is usually filled with people who then claim injuries, said Rich Halberg of the Sacramento, Calif. office of Allstate Insurance.

“Consumer awareness is really important,” he said, noting that California alone has about $1 billion in auto insurance fraud annually.

In a recent survey, Miami was the No. 1 city in America for staged accidents and Los Angeles was No. 2, Halberg said. Houston, Chicago and Philadelphia rounded out the top five and New York City ranked ninth.

Since 2000, police and prosecutors in Miami have made nearly 1,100 arrests in cases with fraudulent claims topping $36 million, said Nina Banister, a spokeswoman for the Florida Division of Insurance Fraud.

Many of the arrests came after authorities funded two prosecutors to prosecute only fraud cases. In the first year, there was a 25 percent increase in arrest and convictions, Banister said.

In Florida, lawmakers also increased the penalties for staging accidents and just this past year heightened the penalties for claiming injuries in so-called “phantom accidents” that never occurred. The laws came after Orlando and Tampa both moved into the top 10 cities for staged accidents.

“We’re trying to keep up with the new twists on these schemes,” Banister said.

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On the Net:

National Insurance Crime Bureau:
https://www.nicb.org/cps/rde/xchg/nicb

New York state Office of Attorney General:
http://www.oag.state.ny.us/

Florida Division of Insurance Fraud: http://www.fldfs.com/fraud/

Coalition Against Insurance Fraud:
http://www.insurancefraud.org/