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Luis G. Aguirre, 59, of Kearny worked as a “runner,” identifying accident victims whom he then introduced to various chiropractors, medical imaging centers and others who billed PIP insurance plans for medically unnecessary services, U.S. Attorney Craig Carpenito said.
Health care providers gave Aguirre $500 in cash for each victim he delivered, the U.S. attorney said.
Aguirre and an employee from an auto body shop in West New York found the victims through word-of-mouth in the community and through relationships with health care providers in North Jersey, Carpenito said.
Aguirre then directed the accident victims to visit specific health care providers to obtain medically unnecessary X-rays, MRIs and other unnecessary exams or services for phony or exaggerated injuries from the crashes, the U.S. attorney said.
Aguirre also made sure the victims filed police reports to support subsequent insurance claims, he said.
The providers submitted bogus insurance claims to the victims’ PIP insurance plans, Carpenito said.
Aguirre paid an undisclosed amount of money per victim to his accomplice, who, in turn, paid them, he said.
In one instance, Carpenito said, a North Bergen resident’s car was rear-ended at a red light in Elizabeth.
According to the police report, the North Bergen resident refused medical treatment at the scene.
The auto body shop worker learned that the resident “was willing to participate in the scheme in exchange for cash payment,” Carpenito said.
So Aguirre had the victim visit an MRI Center in Rochelle Park for a series of medically unnecessary X-rays that were billed to the victim’s insurance policy.
Aguirre’s participation in the conspiracy caused an estimated loss to PIP insurance plans of over $250,000, with total losses caused by the conspiracy exceeding $3.5 million, the U.S. attorney said.
U.S. District Judge Stanley R. Chesler scheduled sentencing July 14 in Newark on Aguirre’s conspiracy to commit health care fraud conviction.
Carpenito credited special agents of the Department of Labor – Office of Inspector General (DOL-OIG) and the FBI with the investigation leading to Tuesday’s guilty plea, secured by Assistant U.S. Attorney Jason S. Gould of his Health Care Fraud Unit in Newark.
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