They paid people to stage crashes. They bilked insurance companies for more than $100,000 in medical treatments patients never received and had unlicensed receptionists administer others...
Jan. 25--They paid people to stage crashes. They bilked insurance companies for more than $100,000 in medical treatments patients never received and had unlicensed receptionists administer others.
This week, one of five defendants involved in a large insurance fraud scheme run out of a Naples chiropractic office was convicted after a massage therapist turned state's evidence.
A Collier Circuit jury found Esmaeel Samaliazad, 49, guilty of organized scheme to defraud, insurance fraud involving more than $20,000 and insurance fraud involving less than $20,000. He was the first to go to trial.
"It basically was a fraud factory and they paid people to actually be patients," Statewide Prosecutor Michael Anthony Pica told jurors during his summation Tuesday. "(Patients) were paid, they staged an accident and then they didn't receive treatments. This was a very corrupt clinic."
Prosecutors say the alleged ringleader, Feghen Delva, 44, a chiropractic assistant, set up Cardinal Chiropractic Center on 10th Street North in July 2008.
They say he paid Samaliazad and another chiropractor a monthly fee to be straw owners to avoid state licensing requirements. Samaliazad worked in Naples two days weekly and three days at Delva's sister clinic, Premier Spine & Rehab in Fort Myers, earning $450 daily
The clinic initially began in Miami, prosecutors say, but couldn't recruit enough patients. In Naples, however, it flourished.
"Insurance companies were being billed for people who weren't even in the country. They were in Haiti," Pica told jurors.
Court records provide this account:
Maralis Quiñones Dort, a receptionist, alerted state investigators to the fraud in April 2009. The Division of Insurance Fraud and the Office of the Attorney General's Statewide Prosecutor, assisted by the National Insurance Crime Bureau, Geico and Direct General, began looking into possible criminal activities.
Dort told investigators Direct, Geico and three other insurance companies were targeted due to quick payout policies on PIP (Personal Injury Protection) claims.
Delva hired recruiters to find Hispanics to be at-fault drivers, paid to crash into vehicles. Haitians were recruited to be in vehicles that were hit, those deemed not at fault, and they became patients. But they never forked over a 20 percent copay. Instead, Delva paid them $2,000 for agreeing to undergo 40 treatments.
Patients and others involved in the crashes flocked to the clinic on Fridays to get paid.
Chiropractors and massage therapists "upcoded" and double-billed for treatments, some of which were never administered. When Samaliazad and massage therapist James Greenhut weren't in the office, Dort and other receptionists administered treatments, although they weren't licensed.
Patient recruiter Guerold Dolcine also worked as Delva's lookout, sitting outside watching for insurance or government inspectors. He updated Delva by cellphone and admitted he recruited about five patients monthly and was paid $600 every two weeks.
Investigators interviewed employees, former employees and patients and on Oct. 2, 2009, they seized records at Cardinal, Premier and Apex Diagnostic in Palm Beach County, which handled their billings.
In May 2012, five people were arrested; many others weren't charged.
Last week, Greenhut, 54, pleaded guilty. Dolcine, 38, pleaded guilty in November to obtaining more than $50,000 by fraud and was sentenced to time served in county jail.
Delva and office manager Marie Stephania Zamy, 28, will have a joint trial in March. They also face grand theft charges and Delva faces a money laundering charge.
In Samaliazad's taped statement, which was played for jurors, he said when he discovered the fraud, he confronted Delva and told him the patient payments and bogus billings had to stop. He said he was unaware of the fraud when he signed claim forms, and quit in late 2009.
During closing arguments Tuesday, Pica told jurors Samaliazad knew of the fraud, pointing out his testimony contradicts his taped statement. He contended Samaliazad went along with it because he earned more than $100,000 yearly working in Naples two days per week and three days at Premier, in Fort Myers, earning $450 daily.
"A $100,000 salary is a bit of an incentive," Pica said. "By looking away during so many incidents, he allowed the fraud to go on."
Defense attorney Lee Hollander told jurors Delva told Greenhut to keep Samaliazad "in the dark" and pointed out Greenhut's plea deal ensures that if he testifies against the defendants, he'd get five years' probation, not 30 years.
"In order to accept the state's version of the case, you'd have to believe he's gone through all the training and that he's going to put his entire professional career at risk -- and his freedom," Hollander said of Samaliazad, telling jurors he also is certified as a chiropractic neurologist and teaches at Edison State College.
Showing no emotion, Samaliazad stood and pursed his lips as the court clerk read the verdict Tuesday evening. The chiropractor, who lives and works in Fort Myers, faces up to 15 years in a state prison on the top offense and five years each for the others.
Hollander, Pica and co-counsel Michael Nieman declined to comment until after sentencing, but Hollander intends to appeal. Judge James Shenko revoked Samaliazad's $400,000 bond and ordered him jailed pending sentencing Feb. 28.
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