Q. I received a call from the hospital after my accident telling me to come in for a follow-up appointment. Is this legit?
A. No. Just hang up and don’t go in because you’re about to get involved in medical insurance fraud.
The caller will usually make you think they are calling from the hospital and say something like, “You were in the hospital yesterday, and I am calling to set up your follow-up appointment.”
These calls frequently occur in the New York City area, especially in the Bronx, Brooklyn, and Queens.
If You Receive a Call from the Hospital After Your Accident, You Are Being Scammed!
If you receive a call after your accident to set up a follow-up appointment or asking you to come into anyone’s office, you are being scammed. The hospital will never call you to set up a follow-up appointment.
The best scam I heard was from a client who said he received a call from Mr. Goldberg at the Department of Social Concern Division of Rights! Mr. Goldberg sent him to their doctor who was certified. We immediately sent our client to another doctor.
What Should You Do If You Receive a Call from the Hospital after Your Accident?
Immediately hang up the phone and do not say anything. If you say anything, just say I already have a doctor and a lawyer and hang up. Then call an accident lawyer in New York who doesn’t pay for your information.
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How Did The Doctor Get My Name and Phone Number?
Your name and telephone number were sold to a medical clinic or a “runner” by EMS on the ambulance or by someone working in the hospital emergency room. What is a runner?
Then you get a call from the doctor’s office / medical clinic asking you to come in for your “follow-up” appointment.
When you go for your “follow-up” appointment, you will be seen by several doctors including an orthopedic surgeon, chiropractor, and psychologist. These doctors are not interested in treating you for your injuries, but they are interested in billing insurance companies or Medicare.
You may also be asked to sign a retainer with a particular accident lawyer. Lawyers also illegally pay ambulance and hospital employees for your information. If you receive a call from a lawyer after your accident, hang up quickly!
A lawsuit by one personal injury lawyer against other personal injury attorneys states that an attorney, William R. Hamel, (paragraphs 22-23) was convicted upon his guilty plea to the reduced charge of criminal solicitation in the fourth degree for paying an employee at Lincoln Hospital in the Bronx. The complaint also states Mr. Hamel testified that while working for the Schwitzer Law Firm attorney William Dinkes was involved in a scheme paying hospital employees $500 for referring personal injury clients.
What Can Happen to You?
This entire scheme is illegal. Everyone who participates in this scheme to defraud insurance companies has committed a crime, except for you unless you have also been paid money.
Almost every year, doctors and accident lawyers are arrested. Attorney William R. Hamel, (paragraphs 22-23) was convicted upon his guilty plea to the reduced charge of criminal solicitation in the fourth degree.
It’s not good for your case if your doctor or lawyer gets arrested!
What Can Happen to Your Accident Case?
While it is not a crime to be caught up in insurance fraud if you are not a willing participant, the downside for you is that these medical clinics can seriously hurt your case if you have a real injury.
The insurance companies know which medical offices are engaged in fraud and if you are treated at any of these medical offices, it will be very difficult to settle your case and the insurance company will offer very little.
If you have an existing accident case when you go to one of these medical clinics, you could easily ruin your existing personal injury case.
Real Example #1
We were asked by a chiropractor in Queens to have dinner. At dinner, the chiropractor said he managed a medical clinic and offered to send us cases in Queens and the Bronx because he heard we are good personal injury lawyers. We were suspicious and declined to accept cases from the chiropractor.
It turned out we were right. A couple of years later, the chiropractor was arrested by the FBI. It’s a good thing we never got involved with those cases. Although many of the cases were fraudulent, some of them were probably legitimate, but it would be impossible to settle them once the doctor was arrested.
If you had been to one of the doctors in his medical clinics for a legitimate accident, your case would likely not have been settled, or it would have been settled for a small amount of money, and the insurance company would be coming after you to get it back.
The NY Times wrote, “…a lawyer whose firm mainly represents insurers, said he found at least eight cases that seem suspicious because of the lawyers and doctors involved.”
“…another lawyer who represents plaintiffs, said his firm was trying to get out of a number of cases it had recently taken on from one of the lawyers identified by prosecutors.”
If you had a real accident with real injuries, don’t let this happen to you. Be careful which doctors you see and who your personal injury lawyer is.
Real Example #2
We represented a woman who injured her neck when she fell in a warehouse store. Her doctor scheduled surgery for her neck. But before her surgery, she had a car accident which only caused a minor injury.
From the scene of the car accident, she was taken to the hospital by ambulance. Her name and phone number were sold to a medical clinic. The next morning, she received a call from the medical clinic saying she needed to come in for her follow-up visit after the emergency room.
When she went to the medical clinic, an orthopedic surgeon and chiropractor wanted to treat her for neck and back pain which she did not have. They also wanted her to be seen by their psychologist. Fortunately, she refused treatment and ran out of there.
We settled her case for the entire $1 million insurance policy, but if she allowed the clinic doctors to treat her for neck pain, the insurance company for the warehouse would have argued that her neck was injured in the car accident and that the surgery was needed because of the car accident.
Real Example #3
We represented two clients who were injured in a car accident. After going to Jacobi Hospital in the Bronx, they received a call from a medical clinic where they began treatment. Several weeks later they looked for an accident lawyer and called us.
We told our clients to immediately stop treatment at the medical clinic, and we gave them the name of a well-known orthopedic surgeon. Within a few months, we received a letter from State Farm Insurance SIU (Special Investigations Unit) stating that the medical clinic was being investigated for fraud.
Fortunately, they only had a few visits at the medical clinic and switched to a legitimate orthopedic surgeon. Both cases were settled for the entire $100,000 insurance policy.
Why Is This Happening?
The answer is simple, money! The ambulance and emergency room people who sell your information do it to make extra money. The runner who sells your information to the doctor and accident lawyer makes a lot of money. Runners typically sell your information to the doctor for $1,500 and to the accident lawyer for $1,500 for a total of $3,000!
The doctor buys your information so he or she can give you all kinds of useless medical treatment and x-rays, giving you unneeded harmful radiation, just so they can bill your insurance company for a lot of money.
The accident lawyer pays for your information because accident lawyers make a lot of money on each case.
Legitimate accident claims do not raise insurance rates, but fraudulent medical billing has a big effect on raising everybody’s insurance premiums.
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Philip L. Franckel, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York; He has a 10 Avvo rating; Avvo Client’s Choice with all 5-star reviews; Avvo Top Contributor; and a former Member of the Board of Directors of the New York State Trial Lawyers Association.
Robert Plevy, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York. Rob began his legal career in 1993 as an Assistant Corporation Counsel defending The City of New York against personal injury lawsuits.