According to Insurance Journal and U.S. Attorney Damian Williams, Bradley Pierre of Closter, NJ has officially pleaded guilty for his role in coordinating $60-$70 million no-fault auto insurance fraud scheme in the state of New York, one of the largest the state has ever seen. And it is INVOLVED.
Insurance Journal highlights the details of the case:
“The original indictment identified counts of health care fraud, money laundering, bribery, identity theft and fraud against the IRS as part of a more than a decade long scheme that involved medical clinics, doctors, business associates and law firms, including his wife’s firm.”
“Pierre took advantage of a feature of New York and New Jersey no-fault insurance laws that requires insurers to pay auto insurance claims automatically for certain types of motor vehicle accidents, provided that the claim is legitimate and below a particular monetary threshold. Insurance companies will often pay medical service providers directly for the treatment they provide to automobile accident victims without the need to bill the victims themselves.”
“According to court records, from about 2008 to 2021, Pierre agreed with others to unlawfully own and run medical clinics located in the New York area including, among others, Veda Medical, Sky Medical, Sun Medical, and Rutland Medical. Because clinics are unable to bill insurance companies for no-fault benefits if they are controlled by non-physicians, Pierre convinced doctors and others to submit bills to insurance companies falsely representing that the clinics were owned and operated by licensed doctors, and for the doctors to lie under oath during Examinations under Oath (EUOs) about the ownership, control, and finances of the clinics.”
“Pierre used his control of the clinics for personal profit. According to prosecutors, between 2008 and 2021, he took more than $20 million from the clinics by either transferring the funds directly to bank accounts under his control or using the clinics’ bank accounts to pay his personal finances.”
“He also used his control of the clinics to steer prescriptions to pharmacies in return for more than $1 million in kickbacks and to steer patients to seek legal representation from law firms he conspired with including the law firm run by his wife, Nonna Shikh. The law firms then filed lawsuits against insurance companies on patients’ behalf. Pierre maintained an office at the Shikh firm and was actively involved in the legal practice as a manager, according to prosecutors.”
“Pierre used his control of the clinics and the law firm to also steer patients to magnetic resonance imaging (MRI) services at another medical facility over which he exercised substantial control. The purported sole owner of the MRI facility, who was a doctor, agreed to falsely report injuries in MRI reports, which allowed the clinics to bill insurance companies for additional, unnecessary medical services and allowed attorneys to falsely claim injuries in lawsuits against insurance companies. The doctor also agreed to lie to insurance companies about Pierre’s role in the MRI facility.”
“According to the indictment, the conspirators billed insurers for as much as $70 million in fraudulent medical claims.”
“Pierre hid his control over several of the clinics and the MRI facility using phony loan arrangements. He purportedly gave $10 million in loans to two clinic operators in return for a percentage of any later payments by insurance companies. He was paid back $2.4 million more than he lent, the indictment indicates. He further concealed payments from the no-fault facilities to his firm by using check cashers, transferring funds to shell companies under his control, and arranging for funds to be paid to a sibling.”
“To fill the clinics and the MRI facility with patients, prosecutors said Pierre arranged for bribes to be paid to hospital employees, 911 dispatchers, and others to obtain the confidential names and numbers of motor vehicle accident victims. He and others he hired would then induce these victims to receive medical treatment at Pierre’s clinics and legal representation from his wife’s law firm. Pierre paid one recruit to this scheme more than $800,000, according to court records.”
“Pierre bribed medical offices to send patients to the MRI facility, the indictment said. These medical offices included, among others, Epione Medical Center and Modern Brooklyn Medical.”
“Finally, Pierre engaged in tax evasion, utilizing two companies: Medical Reimbursement Consultants and Marketing 4 You. Pierre hid income from the IRS and paid personal expenses from MRC and M4Y’s bank accounts but improperly reported these payments as “business expenses.” These included payments for his wedding, home renovations, jewelry, furniture, luxury clothing, travel, and gifts. In total, prosecutors said Pierre underreported income, falsely reported expenses of over $4 million, and deprived the IRS of approximately $1.5 million in taxes due.”
Pierre pleaded guilty to conspiracy to commit bribery and conspiracy to defraud the Internal Revenue Service (IRS), and is scheduled to be sentenced in May 2024.