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QUEENS---A physician employed at a Queens Village medical clinic has been charged with insurance fraud for falsely billing insurance carriers under New York's no-fault law for costly medical tests never provided to motor vehicle accident victims --- including an undercover investigator.
"No-fault fraud and abuse is a billion dollar a year business in New York fueled by crooked health care professionals", Queens district attorney Richard Brown said. "Such rip-offs are costing the typical New York motorist $300 to $400 a year in higher insurance premiums and are the major reason why New York's automobile insurance coverage costs an average of nearly $2,000 per driver, the second highest in the nation. This arrest sends a clear message to those who are attempting to fleece the system for their own personal gain that law enforcement's fight against insurance fraud is ongoing and that those who cheat will be sought out and vigorously prosecuted."
The district attorney said that under New York's no-fault law, a person injured in a motor vehicle accident can receive up to $50,000 coverage for medical expenses incurred as a result of an accident. Most health providers are reimbursed directly by the insurance carriers for services provided.
James T. Gilas, 42, of 321 Kensington Road, Lynbrook, who maintains a private practice at 410 East 189th Street in the Bronx, and also practices at Cambria Medical, located at 221-10 Jamaica Avenue in Queens, has been charged with four counts of insurance fraud in the third degree, two counts of grand larceny in the third degree, one count of insurance fraud in the fourth degree, five counts of falsifying business records in the first degree and one count of grand larceny in the fourth degree. If convicted the defendant faces up to seven years in prison.
Brown said that as alleged in the complaint, between January and July 2004, the defendant submitted insurance claims for costly needle electromyographs (EMGs) that, in fact, were not performed on six individuals. An EMG is a medical test which is used to help diagnose diseases that damage muscle tissue, nerves or the junction between nerve and muscle, and to evaluate the cause of muscle weakness, paralysis and other symptoms. The defendant is alleged to have caused fraudulent claims for these unrendered and unnecessary medical tests to be submitted to a number of no-fault insurance companies in an amount totaling more than $18,000.
According to the allegations, at one point in the investigation, a detective assigned to the New York City Police Department's Fraudulent Accident Investigation Squad went to the defendant's office at Cambria Medical in June 2004 and pretended to have been injured in an auto accident. It is further alleged that subsequent to being examined by Dr. Gilas, Kemper Insurance Company - the undercover's supposed insurance carrier - received a bill and accompanying test results from the defendant for an EMG test in excess of $3,000 that had never been provided.
Among the other insurance companies allegedly victimized by the defendant's scheme were Regal Insurance Company, Auto One Insurance Company, Farm Family Casualty Insurance Company and Liberty Mutual Acquired Prudential Commercial Insurance Company.
The district attorney said the matter would be referred to the New York State Department of Health's Office of Professional Medical Conduct for a review of the defendant's license. 12-21-05
© 2005 North
Country Gazette
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