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Auto insurer sues rehab clinics
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Toronto Star- A group of Toronto area medical rehabilitation clinics used the signatures of 11 doctors in submitting almost 600 phony treatment claims totaling about $1.4 million, one of the country’s biggest auto insurers alleges.
The Co-operators General Insurance Co. and a subsidiary say in a lawsuit that they have paid out about $400,000 for services, supportive devices and expenses to four companies for services that doctors and specialists never recommended or provided in 2009 and 2010.
The Guelph-based insurers added in the claim that the firms and six individual defendants are still filling out requests for assessments in the name of the doctors. Furthermore, Co-operators continues to receive invoices from the centres, the claim noted.
Co-operators is the sixth insurer to sue the group and its top officials and is seeking $2 million in damages for fraud, fraudulent representation, conspiracy and unjust enrichment; another $5 million in aggravated or punitive damages plus legal costs.
The defendants include Pacific Assessment Centre and director Vitali Tourkov; Fairview Assessment Centre, director Alexandre Lobatch and manager Yaniv Tamsout; Century Diagnostic & Assessment Centre and director Pavlo Tsysar; a numbered company and director Abram Zilber; and M.D. Consult Inc. also known as Toronto Regional Medical Assessment Centre and director Danny Grossi.
“All or some of the defendants have been submitting false and/or fraudulent treatment plans, requests for assessment, and/or invoices to Co-operators on an ongoing basis,” the insurer said in the 24-page claim that it filed in the Ontario Superior Court of Justice late last week.
Joseph Falconerin, a lawyer for Grossi, said Tuesday that they have no comment except that “the allegations against Dr. Grossi are frivolous and without merit.”
“It seems that The Star is becoming a tool of the Insurance Bureau (of Canada),” he added. “Again, I must counsel you to govern yourself accordingly.”
None of the other individual defendants or company representatives could be reached for comment on the allegations, which must still be proven in court.
The claim follows a July story in the Star that reported bogus assessment clinics are running a billion-dollar scam, according to some insurers. Those clinics and related firms are alleged to have sent fake accident treatment charges to insurance firms for payment.
The Co-operators alleged in its claim that Pacific, Fairview and Century submitted “false and fraudulent documentation” that was “purported to have been signed by doctors” who did not work for the centres.
“This documentation included requests for services and assistive devices that these doctors never recommended,” the claim added.
The claim charged the doctors, who purportedly signed the phony documents, worked for Toronto Regional Medical Assessment Centre and/or Grossi.
The Co-operators identified 11 doctors in the claim whose electronic signatures were allegedly used fraudulently in the scheme. In an 18-page appendix, the company included details of 578 alleged false documents that it received using the doctors’ names.
The name of one doctor appeared on 175 documents that Fairview and Pacific used for allegedly false claims on treatments such as $1,841 for “home exercise”, $2,475 for “chronic pain” and $2.345 for “spinal decompression.”
“The documentation is false and fraudulent and includes references to services and assistive devices that were not recommended…,” the claim noted.
Another page, involving claims allegedly signed by an orthopedic surgeon, described a supporting device for treatment as “a whole body vibrating plate” with a price of $1,980. But Co-operators said it never recommended it.
Co-operators also said it relied on all information in a claimant’s file including information in treatment plans and requests for assessments in determining the value of injuries for settlements.
“The submission of false documentation has skewed this determination, causing an unknown quantum of damages…,” the claim said.
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