A New Jersey resident admitted to his role in a car accident scheme that required healthcare providers to perform unnecessary services—such as x-ray and MRI exams—for exaggerated victims’ injuries and then bill for the fraudulent work.
Luis G. Aguirre, from Hudson County, plead guilty in front of U.S. District Judge Stanley R. Chesler in federal court, according to a March 10 news release from the U.S. Attorney’s Office. He faces one count of conspiracy to commit healthcare fraud, which carries a maximum penalty of 10 years in prison and a $250,000 fine or "twice the gross gain or loss from the offense."
As part of the scheme, Aguirre recruited individuals who had been in car accidents with help from an auto body shop in New Jersey, along with healthcare providers he knew in the state. Aguirre paid the body shop workers money for each victim sent his way; that same automotive employee then paid accident victims for taking part in the car accident scheme.
Aguirre would then tell the person involved in the accident plot to visit a specific healthcare clinician to “obtain medically unnecessary medical exams and services, such as x-rays and MRIs, for fake or exaggerated injuries that they supposedly suffered during the automobile accidents,” according to the statement.
The healthcare practitioner gave Aguirre about $500 in cash for each car crash victim that he brought in. That provider would then submit a fraudulent insurance claim to personal injury protection insurance plans.
In total, the Hudson County resident’s scheme resulted in more than $250,000 in losses to insurance plans and a total loss of more than $3.5 million, according to the release.
Sentencing for the case is scheduled for July 14.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.