A Hudson County, New Jersey, man, Luis G. Aguirre, 57, was sentenced on Oct. 5 to 12 months and one day 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 scheme, health care practitioners fabricated and exaggerated accident victims’ injuries to support fraudulent insurance claims to Personal Injury Protection (PIP) insurance plans for medically unnecessary services.
U.S. District Judge Stanley R. Chesler also sentenced Aguirre to three years of supervised release and ordered him to pay restitution of $53,710.
In March, Aguirre pleaded guilty in Newark federal court to an information charging him with one count of conspiracy to commit health care fraud.
Chesler imposed the sentence on Oct. 1 by videoconference. 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 insurance plans of more than $250,000. The total loss caused by the conspiracy 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 victims 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 West New York, Individual-1, identified 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 to 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 accident victims to visit specific health care providers 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.
Quid-pro-quo
Aguirre was paid approximately $500 in cash by the health care providers for each accident victim he delivered. Health care providers submitted 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 in a vehicle accident in Elizabeth.
U.S. Attorney Carpenito stated that 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 police 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 scheme 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 S. Gould of the Health Care Fraud Unit at the U.S. Attorney’s Office in Newark.
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