WESTCHESTER COUNTY---A total of $2,206,416.46 in restitution checks has been issued to insurance companies victimized by Elm Street Medical, a medical mill fraud enterprise, which operated over a period of approximately five years.

Elm Street Medical, operating out of One Elm Street, Tuckahoe, bilked insurance companies by exploiting the no-fault provisions of the New York State Comprehensive Motor Vehicle Insurance Reparations Act which entitles persons injured in automobile accidents to a maximum of $50,000 of medical coverage regardless of who is at fault, Janet DiFiore, Westchester district attorney said.

Elm Street Medical defrauded dozens of insurance companies by upcoding (i.e. the submission of claims containing codes for expensive medical services never provided) or by submitting bogus claims for medical services on behalf of patients who had not been in a car accident.

DiFiore said Elm Street's physicians would routinely recommend numerous and medically unnecessary tests or treatments including physical therapy treatment; chiropractic services; dental evaluations, testing and treatment; orthopedic evaluations; psychiatric evaluations and treatment; psychological evaluations and treatment; neurological evaluations and testing; durable medical goods; and excessive diagnostic testing all provided for at the Elm Street facility.

Some of the procedures that were billed for were never performed and others were shams. For example, a simple five minute procedure would be routinely upcoded and billed for a more complicated and longer higher reimbursement procedure. All of the patients were required to assign all their insurance payments to Elm Street. Patients also received a promise of proceeds from any potential lawsuit as a result of their injuries.

DiFiore presented checks to representatives of several of the insurance companies victimized by the fraud.

"The millions of dollars involved in this type of fraud is a tremendous drain on the auto insurance industry and the fraud perpetrated directly impacted auto insurance rates in Westchester County." commented DiFiore, "By obtaining convictions, in addition to recovering much of the money stolen, Westchester County residents can have some measure of assurance that their insurance bills are not being artificially inflated by greed, fraud and corruption."

Of the 38 people charged in the investigation, 37 have been convicted and one fled the jurisdiction. Six physicians, in addition to criminal sentencing, lost their licenses to practice medicine.

An additional $169,000 dollars in restitution is currently outstanding and will be paid by two of the defendants over the course of their probation. 3-26-07

© 2007 North Country Gazette